Individual provider Active NPI

Charles Samuel Stevens, MD

  • Dermatopathology (Pathology) Physician
  • San Antonio, TX
National Provider Identifier
1982603171
Registry record updated Aug 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X
License
E8936 Issued in TX
Practice address
1122 Austin Hwy
San Antonio, TX 78209-4844
Phone
(210) 342-6488
Fax
(210) 342-6725
NPI assigned
Jul 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X E8936 TX Primary
Dermatopathology Physician 207ND0900X E8936 TX

Addresses

Primary practice location

1122 Austin Hwy
San Antonio, TX 78209-4844

Mailing address

221 W Kings Hwy
San Antonio, TX 78212-2965
Phone (210) 736-5043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110831000707 TX Practitioner - Pathology 4587577366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical School at San Antonio, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Austin Pathology AssociatesGroup PAC ID 7012902539, 76 clinicians

Practice addresses (Care Compare)

5 Champions Mark
San Antonio, TX 78258-7701
Phone (210) 342-6488

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E8936TXMDDermatopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Pathology Associates CurrentSince Jun 1, 2011 Accepting new patients
Austin Pathology Associates Past Accepting new patients

Locations

4900 Mueller Blvd
Austin, TX 78723
Phone (512) 324-0165

2000 Scenic Dr
Georgetown, TX 78626
Phone (512) 863-2117

1122 Austin Hwy
San Antonio, TX 78209
Phone (210) 342-6488

Organizations & group practices 2

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344470400000",
    "number": "1982603171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 W KINGS HWY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782122965",
            "telephone_number": "210-736-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 AUSTIN HWY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782094844",
            "telephone_number": "210-342-6488",
            "fax_number": "210-342-6725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "CHARLES",
        "middle_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2012-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "TX",
            "license": "E8936",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "E8936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.