Active NPI
Stacey Danielle Little, PA-C
- Medical Physician Assistant
- Chula Vista, CA
National Provider Identifier
1831396415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA16457
- Practice address
- 890 Eastlake Pkwy
Chula Vista, CA 91914-4520 - Phone
- (619) 761-1574
- NPI assigned
- Jun 28, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA16457 | CA | Primary |
Addresses
Primary practice location
890 Eastlake Pkwy
Chula Vista, CA 91914-4520
Mailing address
890 Eastlake Pkwy
Chula Vista, CA 91914-4520
Phone (619) 761-1574
Other practice location 1
890 Eastlake Pkwy
Chula Vista, CA 91914-4520
Phone (619) 761-1574
Other practice location 2
890 Eastlake Pkwy
Chula Vista, CA 91914-4520
Phone (619) 761-1574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16457 | Other | CA | LIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
502 Euclid Ave
National City, CA 91950-2984
Phone (619) 434-4019
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16457 | CA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Pain Management Medical Group | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- National City, CA
- NPI 1598953960
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- Chula Vista, CA
- NPI 1447768197
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- National City, CA
- NPI 1902330285
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Comfort and Thrive Home Health
- Home Health Agency
- San Diego, CA
- NPI 1588053177
-
dba Active Health Services
- Home Health Agency
- San Diego, CA
- NPI 1598174104
-
- Home Health Agency
- San Diego, CA
- NPI 1114206976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621987200000",
"number": "1831396415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "890 EASTLAKE PKWY",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919144520",
"telephone_number": "619-761-1574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "890 EASTLAKE PKWY",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919144520",
"telephone_number": "619-761-1574"
}
],
"practiceLocations": [
{
"address_1": "890 Eastlake Pkwy",
"address_purpose": "LOCATION",
"city": "Chula Vista",
"state": "CA",
"postal_code": "919144520",
"country_code": "US",
"telephone_number": "619-761-1574",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "890 Eastlake Pkwy",
"address_purpose": "LOCATION",
"city": "Chula Vista",
"state": "CA",
"postal_code": "919144520",
"country_code": "US",
"telephone_number": "619-761-1574",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LITTLE",
"first_name": "STACEY",
"middle_name": "DANIELLE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-28",
"last_updated": "2021-05-26",
"certification_date": "2021-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA16457",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC",
"identifier": "16457",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.