Kristina Marie Stallard, MS, RN, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.019367 Issued in OH

Practice address

9000 N Main St Ste G-36
Englewood, OH 45415-1183

Phone

(937) 293-1622

Fax

(937) 245-6308

NPI assigned

Jun 20, 2016

Last updated

Sep 16, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH, VA, DC, CT4 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 4

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vivo Infusion Virginia LLCGroup PAC ID 3779928577, 3 clinicians

Id Consultants, IncGroup PAC ID 7012995574, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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

• Id Consultants Inc

  • Infusion Therapy Clinic/Center
  • Beachwood, OH
  • NPI 1124058920
  Medicare reassignment Care Compare group NPD
• Vivo Infusion Virginia LLC

  • Infusion Therapy Clinic/Center
  • Glen Allen, VA
  • NPI 1902652340

  DC

  Medicare reassignment Care Compare group NPD
• Civic Farmington, PLLC

  • Infusion Therapy Clinic/Center
  • Farmington, CT
  • NPI 1760138366
  Medicare reassignment NPD
• Civic North Haven, LLC

  • Infusion Therapy Clinic/Center
  • North Haven, CT
  • NPI 1164196283
  Medicare reassignment NPD
• Civic Wilton, PLLC

  • Infusion Therapy Clinic/Center
  • Wilton, CT
  • NPI 1508375064
  Medicare reassignment NPD
• Infusion Center of Pennsylvania LLC

  • Infusion Therapy Clinic/Center
  • Royersford, PA
  • NPI 1689048720
  NPD
• Vivo Infusion Virginia LLC

  • Infusion Therapy Clinic/Center
  • Midlothian, VA
  • NPI 1972295277
  NPD
• Id Consultants of Northeast Ohio, Inc

  • Infectious Disease Physician
  • Beachwood, OH
  • NPI 1255913117
  NPD (past)
• Infusion Associates of Ohio LLC

  • Infusion Therapy Clinic/Center
  • Toledo, OH
  • NPI 1144966466
  NPD (past)

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1972953032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6680 POE AVE STE 200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454142855",
            "telephone_number": "937-280-8400",
            "fax_number": "937-245-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST STE G-36",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "454151183",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3120 Governors Place Blvd",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454091328",
            "country_code": "US",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8881 N Main St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454151333",
            "country_code": "US",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALLARD",
        "first_name": "KRISTINA",
        "middle_name": "MARIE",
        "credential": "MS, RN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.019367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0184844",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstallard69152@direct.premierhealth.com",
            "affiliation": "N",
            "address_1": "9000 N Main St Ste G-36",
            "city": "Englewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454151183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelsey Marie Smith, LMT
• Maria L Smith
• Nicholas Smith
• Nicole Amber Smith, L.P.N.
• Regina Sowah, STNA
• Glenn Stanton
• Heather Stoner
• Melaney Strain, PTA
• Trisha M Strayer, NP-C
• Julie Streck

• Family Nurse Practitioner in Englewood, OH
• Providers in Englewood, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.

Verify at the official NPI Registry.