Individual provider Active NPI

Stacey Brown Daffron, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1871921817
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005147 Issued in MD
Practice address
3001 S Hanover St
Baltimore, MD 21225-1233
Phone
(410) 350-3200
NPI assigned
Oct 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0005147 MD Primary

Addresses

Primary practice location

3001 S Hanover St
Baltimore, MD 21225-1233

Mailing address

201 Defense Hwy
Ste 100
Annapolis, MD 21401-8902
Phone (443) 481-5597

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140127000572 MD Practitioner - Physician Assistant 3375772171 Reassigns benefits to 3 organizations
I20171117000537 DC Practitioner - Physician Assistant 3375772171

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0005147MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Nov 6, 2017 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jul 31, 2019 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jul 31, 2019 Accepting new patients
Harbor Hospital Past Accepting new patients

Locations

2000 Medical Pkwy
Ste 101
Annapolis, MD 21401
Phone (410) 295-8900

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

201 Defense Hwy
Ste 150
Annapolis, MD 21401

15500 Annapolis Rd
Ste 102
Bowie, MD 20715
Phone (301) 805-0190

Organizations & group practices 6

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 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": "1383091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1871921817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DEFENSE HWY",
            "address_2": "STE 100",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214018902",
            "telephone_number": "443-481-5597",
            "fax_number": "443-481-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 S HANOVER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251233",
            "telephone_number": "410-350-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAFFRON",
        "first_name": "STACEY",
        "middle_name": "BROWN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-30",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.