STACY ANTOINETTE JEFFERSON (NPI# 1720492028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720492028 |
| Entity Type | Individual |
| Full Name | STACY ANTOINETTE JEFFERSON |
| Credential | M.D. |
| Practice Address |
180 S 3rd St Suite 300 Belleville IL 62220-1952 |
| Practice Telephone | 6182335480 |
| Mailing Telephone | 6182335480 |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2016-08-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 125065259 | IL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 125065259 | IL | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841824828 | Stacy Duhe Jefferson | Counselor | 1009 Polly Ave., Baytown, TX 77520 | 2020-02-27 |
| 1861645574 | Stacy Wayne Jefferson | Licensed Practical Nurse | 432 N Green St, Georgetown, OH 45121-1011 | 2008-10-25 |
| Street Address |
180 S 3RD ST SUITE 300 |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62220-1952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477548238 | Rhonda G Ozanian | Social Worker | 180 S 3rd St, Suite 400, Belleville, IL 62220-1952 | 2005-09-16 |
| 1346690625 | Dane Bay | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2016-06-16 |
| 1518317056 | Joseph August Yoha | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2016-06-15 |
| 1548610017 | Daniela Vincent | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2016-06-15 |
| 1568811321 | Marcus R Hennon | Family Medicine | 180 S 3rd St, Belleville, IL 62220-1952 | 2016-06-11 |
| 1518316728 | Sana Usman | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2016-06-08 |
| 1053769992 | Michelle Baker | Family Medicine | 180 S 3rd St, Belleville, IL 62220-1952 | 2016-06-01 |
| 1356722151 | Imran Khan | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2015-06-17 |
| 1790166965 | Jennifer Woosley | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2015-06-14 |
| 1619358900 | Gretta Carroll | Family Medicine | 180 S 3rd St, Suite 300, Belleville, IL 62220-1952 | 2015-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144729716 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order Of | Clinic/Center | 180 South Third Street Suite 101, Belleville, IL 62220 | 2018-02-08 |
| 1437675535 | Prorehab PC | Occupational Therapist | 1915 Carlyle Ave, Ste D, Belleville, IL 62220 | 2017-08-21 |
| 1629527650 | Arika Forrest | Nurse Practitioner | 140 Iowa Ave, Belleville, IL 62220 | 2016-10-03 |
| 1861861403 | Belleville Endoscopy LLC | Internal Medicine | 311 West Lincoln St, Suite 101, Belleville, IL 62220 | 2015-09-24 |
| 1962871558 | Antony Frierdich | Specialist/Technologist | 22 South 13th Street, Belleville, IL 62220 | 2015-09-24 |
| 1588032858 | Dana Wright | Pharmacist | 211 South Thrid Street, Belleville, IL 62220 | 2015-09-03 |
| 1629208731 | Lisa Marlow Johnson | Developmental Therapist | 34 Fenwood Dr, Belleville, IL 62220 | 2009-07-23 |
| 1841361623 | Neurological Surgery of Belleville | Neurological Surgery | 340 West Lincoln Street, Suite 540, Belleville, IL 62220 | 2006-11-13 |
| 1689769119 | Kathy Jo Corn | Counselor | 521 W. Main, Suite 201 B, Belleville, IL 62220 | 2006-10-03 |
| 1780609578 | Southern Illinois Health Care Foundation, Inc. | Counselor | 180 S 3rd St Ste 103&104, Belleville, IL 62220 | 2006-07-13 |
| Find all providers in zip 62220 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417591173 | Dimi Dawn Resch | Family Medicine | 373 Roanoke Dr, Belleville, IL 62221-5723 | 2019-11-05 |
| 1013559749 | Christine Evansco | Family Medicine | 105 S 35th St, Belleville, IL 62226-6314 | 2019-10-15 |
| 1851800288 | Republic County Family Clinic, P.a. | Family Medicine | 2337 G St Ste 2, Belleville, KS 66935-2462 | 2017-09-28 |
| 1154854008 | Kurtis William Klecan | Family Medicine | 2337 G St Ste 100, Belleville, KS 66935-2462 | 2017-04-07 |
| 1144753096 | Ace Medical Services LLC | Family Medicine | 929 Ridgecrest Dr, Belleville, IL 62220-3163 | 2017-04-07 |
| 1558743138 | Patrick Nakashima-moran | Family Medicine | 2900 Frank Scott Pkwy W Ste 904, Belleville, IL 62223 | 2015-06-19 |
| 1871993139 | Wayne Bresee Cox II | Family Medicine | 10 Celeste Ct, Belleville, IL 62223-1907 | 2014-08-23 |
| 1811252547 | Jianming Alexander Lau | Family Medicine | 201 3rd St 200, Belleville, MI 48111-2605 | 2012-07-09 |
| 1548531320 | Donald H Buser | Family Medicine | 116 S Fairway Dr, Belleville, IL 62223-2228 | 2012-01-25 |
| 1275824096 | Pc Associates LLC | Family Medicine | 2129 W. Main St., Belleville, IL 62223 | 2011-04-27 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62220 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.