NPIMap

Individual provider Active NPI

Stephanie Alexandra Kubacak, M.D.

  • Internal Medicine Physician
  • Odessa, TX
National Provider Identifier
1821086729
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L8779 Issued in TX
Practice address
8050 E Highway 191 Ste 200
Odessa, TX 79765-8607
Phone
(432) 337-5411
NPI assigned
Oct 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L8779 TX Primary

Addresses

Primary practice location

8050 E Highway 191 Ste 200
Odessa, TX 79765-8607

Mailing address

8050 E Highway 191 Ste 200
Odessa, TX 79765-8607
Phone (432) 337-5411

Other identifiers 2

IdentifierTypeStateIssuer
8CR485OtherTXBCBS
168108203MedicaidTX

Other names 1

  • Stephanie Alexandra Huskey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040930000250 TX Practitioner - Internal Medicine 0143299743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Texas Tech University Health Science Center School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCH Professional CareGroup PAC ID 1658358635, 51 clinicians

Practice addresses (Care Compare)

8050 E Hwy 191
Suite 200
Odessa, TX 79765-8615
Phone (432) 337-5411

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.78 of 100Reported as group
Quality
60.9
Promoting interoperability
100
Improvement activities
40
Cost
66.21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L8779TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCH Professional Care Internal Medicine CurrentSince Jan 1, 2011 Accepting new patients

Locations

8050 E Highway 191
Ste 200
Odessa, TX 79765
Phone (432) 337-5411

315 Golder Ave
Ste B
Odessa, TX 79761
Phone (432) 332-2695

Organizations & group practices 1

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

Hospital & facility affiliations 10

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312761600000",
    "number": "1821086729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8050 E HIGHWAY 191 STE 200",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658607",
            "telephone_number": "432-337-5411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8050 E HIGHWAY 191 STE 200",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658607",
            "telephone_number": "432-337-5411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBACAK",
        "first_name": "STEPHANIE",
        "middle_name": "ALEXANDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-13",
        "last_updated": "2011-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L8779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8CR485",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168108203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "HUSKEY",
            "middle_name": "ALEXANDRA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.