NPIMap

Individual provider Active NPI

Autumn Elisabeth Stevenson, M.D.

  • Family Medicine Physician
  • Flagstaff, AZ
National Provider Identifier
1801092747
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
RS20070379 Issued in NM
Practice address
2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone
(928) 213-6100
NPI assigned
Jun 26, 2007
Last updated
Mar 27, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RS20070379 NM Primary

Addresses

Primary practice location

2920 N 4TH St
Flagstaff, AZ 86004-1816

Mailing address

2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone (928) 213-6100

Other identifiers 4

IdentifierTypeStateIssuer
599878MedicaidAZ
1427335181OtherAZCBQ CLINIC
8HN026OtherCBQ CLINIC
14257335140MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110331000179 TX Practitioner - Family Practice 7416130216 Reassigns benefits to 4 organizations
I20191028002492 NM Practitioner - Family Practice 7416130216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ton Sells HospitalGroup PAC ID 5092768663, 51 clinicians

Practice addresses (Care Compare)

Highway 86 at Topawa Rd
Sells Indian Hospital
Sells, AZ 85634
Phone (520) 383-7285

Hwy 86 and Topawa Rd
Sells, AZ 85634

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RS20070379NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Family Medicine CurrentSince Nov 4, 2019 Accepting new patients
Presbyterian Healthcare Services CurrentSince Nov 4, 2019 Accepting new patients
Ton San Xavier Health Center CurrentSince Aug 1, 2020 Accepting new patients
Ton Sells Hospital CurrentSince Aug 1, 2020 Accepting new patients
Ton San Simon Health Center CurrentSince Aug 1, 2020 Accepting new patients
Ton Santa Rosa Health Center CurrentSince Aug 1, 2020 Accepting new patients
Ton Santa Rosa Health Center Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Ton Sells Hospital Past Accepting new patients

Locations

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

5901 Harper Dr NE
Albuquerque, NM 87109
Phone (505) 823-8233

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

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.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364342400000",
    "number": "1801092747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-213-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-213-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "AUTUMN",
        "middle_name": "ELISABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2013-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "RS20070379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "599878",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBQ CLINIC",
            "identifier": "1427335181",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBQ CLINIC",
            "identifier": "8HN026",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14257335140",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.