Active NPI
Allen J Stuckey, M.D.
- Child & Adolescent Psychiatry Physician
- Elkhart, IN
National Provider Identifier
1982648960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 01047034A
- Practice address
- 2600 Oakland Ave
Elkhart, IN 46517-1533 - Phone
- (574) 533-1234
- Fax
- (574) 537-2652
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 01047034A | IN | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 01047034A | IN | Primary |
Addresses
Primary practice location
2600 Oakland Ave
Elkhart, IN 46517-1533
Mailing address
330 Lakeview Dr
Goshen, IN 46528-9365
Phone (574) 533-1234
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200181130 | Medicaid | IN | |
| 000000202073 | Other | IN | ANTHEM |
| P00024426 | Other | IN | RAILROAD MEDICARE PIN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 01047034A | IN | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314144000000",
"number": "1982648960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 LAKEVIEW DR",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465289365",
"telephone_number": "574-533-1234",
"fax_number": "574-537-2652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 OAKLAND AVE",
"city": "ELKHART",
"state": "IN",
"postal_code": "465171533",
"telephone_number": "574-533-1234",
"fax_number": "574-537-2652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUCKEY",
"first_name": "ALLEN",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2011-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IN",
"license": "01047034A",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IN",
"license": "01047034A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200181130",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000202073",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PIN",
"identifier": "P00024426",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.