Individual provider Active NPI

Kelley Lynn Stem, PA-C

  • Physician Assistant
  • Tallahassee, FL
National Provider Identifier
1790324804
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112914 Issued in FL
Practice address
1401 Centerville Rd Ste 202
Tallahassee, FL 32308-4638
Phone
(850) 877-7241
NPI assigned
Jan 6, 2020
Last updated
Jan 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112914 FL Primary
Medical Physician Assistant 363AM0700X NU

Addresses

Primary practice location

1401 Centerville Rd Ste 202
Tallahassee, FL 32308-4638

Mailing address

1401 Centerville Rd Ste 202
Tallahassee, FL 32308-4638

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200213001206 FL Practitioner - Physician Assistant 1951737857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Florida State University College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

235 E Princeton St
Suite 200
Orlando, FL 32804-5555
Phone (407) 303-1444

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
54.43 of 100Reported as group
Quality
57.3
Improvement activities
0
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Dec 1, 2025 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 1, 2025 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Interoperability endpoints

  • Direct secure messaging: kstem21799@tallahasseememorial.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1790324804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 CENTERVILLE RD STE 202",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 CENTERVILLE RD STE 202",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084638",
            "telephone_number": "850-877-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEM",
        "first_name": "KELLEY",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-06",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112914",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.