NPIMap

Individual provider Active NPI

Stacey Su, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Philadelphia, PA
National Provider Identifier
1801014493
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
MD435046 Issued in PA
Practice address
333 Cottman Avenue
Fox Chase Cancer Center
Philadelphia, PA 19111
Phone
(215) 728-6900
NPI assigned
Apr 22, 2007
Last updated
Apr 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 213675 MA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD435046 PA Primary

Addresses

Primary practice location

333 Cottman Avenue
Fox Chase Cancer Center
Philadelphia, PA 19111

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 728-6900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081111000035 PA Practitioner - Thoracic Surgery 8527127216 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
University of California, San Diego School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-2111

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
213675MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Jan 26, 2021 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Jan 26, 2021 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients
American Oncologic Hospital Past Accepting new patients

Locations

1 Medical Center Blvd
#428
Chester, PA 19013
Phone (610) 874-4044

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

2100 Keystone Ave
Ste 304
Drexel Hill, PA 19026
Phone (610) 394-4744

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

7500 Central Ave
Philadelphia, PA 19111
Phone (215) 214-4100

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Organizations & group practices 9

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 12

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": "1177200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1801014493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-728-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVENUE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19111",
            "telephone_number": "215-728-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "STACEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-22",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "213675",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD435046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.