Stacey E Devine, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

200401383 Issued in NC

Practice address

19485 Old Jetton Rd
Suite 100
Cornelius, NC 28031-6582

Phone

(704) 384-1775

Fax

(704) 384-1776

NPI assigned

Jan 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 1, 2017 through Aug 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Upmc Community Medcine Inc

  • Family Medicine Physician
  • Hermitage, PA
  • NPI 1023806676
  NPD (past)
• Upmc St. Margaret

  • Ambulatory Surgical Clinic/Center
  • Pittsburgh, PA
  • NPI 1750445607
  NPD (past)

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426636800000",
    "number": "1912986852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-9113",
            "fax_number": "704-316-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19485 OLD JETTON RD",
            "address_2": "SUITE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316582",
            "telephone_number": "704-384-1775",
            "fax_number": "704-384-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVINE",
        "first_name": "STACEY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2015-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200401383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900010",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matt Deeringer, MED, ATC
• Nicole Degner, MSPT
• Amy Der
• Madalyn Marie Derrick, LCSW
• Suresh Jayantha Desilva, MD
• Diabetic Special Care
• Diabetic Supply Institute Inc
• Diabetic Support Services, Inc.
• Brittany Nicole Diaconu
• Teresa Dillard, LMFT

• Family Medicine Physician in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.