Individual provider Active NPI

Stevan I Himmelstein, MD

  • Interventional Cardiology Physician
  • Memphis, TN
National Provider Identifier
1902883481
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
20638 Issued in TN
Practice address
1211 Union Ave Ste 965
Memphis, TN 38104
Phone
(901) 435-8550
Fax
(901) 516-0933
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 12664 MS
Cardiovascular Disease Physician 207RC0000X 20638 TN
Interventional Cardiology Physician 207RI0011X 12664 MS
Interventional Cardiology Physician 207RI0011X 20638 TN Primary

Addresses

Primary practice location

1211 Union Ave Ste 965
Memphis, TN 38104

Mailing address

P O Box 1000 Dept 960
Memphis, TN 38148-0001
Phone (901) 435-8550

Other identifiers 4

IdentifierTypeStateIssuer
117357001MedicaidAR
6092182OtherTNBCBS
00115478MedicaidMS
3807173MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12664MSMDInterventional Cardiology Physician
20638TNMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutherland Cardiology Clinic, P.C. Current Accepting new patients
Stern Cardiovascular Center, PA Cardiovascular Disease Current Accepting new patients
Memphis Heart Clinic Cardiovascular Disease Past Accepting new patients

Locations

200 State Highway 30 W
New Albany, MS 38652
Phone (601) 534-7631

7362 Southcrest Pkwy
Southaven, MS 38671
Phone 90127110002272

8060 Wolf River Blvd
Memphis, TN 38138
Phone (901) 271-2272

7460 Wolf River Blvd
Memphis, TN 38138
Phone (901) 516-6792

6025 Walnut Grove Rd
Ste 111
Memphis, TN 38120
Phone (901) 226-2000

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

Interoperability endpoints

  • Direct secure messaging: stevanhimmelstein@sccpc.allscriptsdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1902883481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 1000 DEPT 960",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "901-435-8550",
            "fax_number": "901-516-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 965",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38104",
            "telephone_number": "901-435-8550",
            "fax_number": "901-516-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIMMELSTEIN",
        "first_name": "STEVAN",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "12664",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "20638",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MS",
            "license": "12664",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TN",
            "license": "20638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117357001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6092182",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115478",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3807173",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.