Stephanie L Kulavic, PA-C, ATC
Individual provider Active NPI Physician Assistant · Springfield, IL
NPI 1992261671 · NPPES record last updated Sep 10, 2024
Key facts
- NPI
- 1992261671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085010016 (IL)
- Practice address
- 800 N 1St St
Springfield, IL 62702-3778 - Phone
- (217) 528-7541
- NPI assigned
- Feb 18, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 34
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pana Community Hospital Association
Springfield Clinic, LLP
Practice addresses (Care Compare)
101 E 9TH St
Pana, IL 62557-1716
Phone (217) 562-6246
1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541
15 Founders LN
Jacksonville, IL 62650-3919
Phone (217) 291-1041
1600 W Walnut St
Jacksonville, IL 62650-1136
Phone (217) 245-9541
201 E Pleasant St
Taylorville, IL 62568-1562
Phone (217) 824-3566
301 N 8TH St
Springfield, IL 62701-1041
Phone (217) 528-7541
775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300
800 N 1St St
Springfield, IL 62702-3719
Phone (217) 528-7541
Hospital & facility affiliations
- St Johns Hospital
- Pana Community Hospital
- Taylorville Memorial Hospital
- Memorial Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.83 of 100
- Quality
- 75.65
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.05 of 100
- Quality
- 72.1
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231114003045 | IL | Practitioner - Physician Assistant | 5890142756 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085010016 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pana Community Hospital Association | Current |
Accepting new patients | |
| Springfield Clinic, LLP | Current |
Accepting new patients | |
| Springfield Clinic, LLP | Past | Accepting new patients | |
| Pana Community Hospital Association | Past | Accepting new patients | |
| Pana Community Hospital Association | Past | Accepting new patients |
Locations
15 Founders Ln
Jacksonville, IL 62650
Phone (217) 243-0300
101 E 9th St
Pana, IL 62557
Phone (217) 562-2131
775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300
800 N 1st St
Springfield, IL 62702
301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003
600 N Main St
Taylorville, IL 62568
Phone (217) 287-8855
Interoperability endpoints
- stephanie.kulavic.1@28977.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Surgical Physician Assistant | 363AS0400X | |||
| Physician Assistant | 363A00000X | 085010016 | IL | Yes |
Addresses
Primary practice location
800 N 1St St
Springfield, IL 62702-3778
Mailing address
PO Box 19248
Springfield, IL 62794-9248
Phone (217) 528-7541
Other providers in Springfield, IL
- Matthew J. Kuhn
- Mark Kuhnke
- Allen Kuizin Jr.
- Halina Kulaga
- Suresh Kumar Kulandhaisamy
- Abhishek Kulkarni
- Madhavi Kishore Kulkarni
- Pradeep S Kulkarni
- Ruta R. Kulys
- Adarsh A Kumar
All providers in Springfield, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.