Dr Stacy Lauren Coulthard, MD is a medicare enrolled "Surgery" physician in Jbsa Fort Sam Houston, Texas. Her current practice location is
Brooke Army Medical Center, 3551 Roger Brooke Drive, Jbsa Fort Sam Houston, Texas. You can reach out to her office (for appointments etc.) via phone at
(210) 916-5102.
Dr Stacy Lauren Coulthard is licensed to practice in Virginia (license number 0101246005) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1982864179.
Physician's Profile
| Full Name | Dr Stacy Lauren Coulthard |
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| Gender | Female |
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| Speciality | Surgery |
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| Location | Brooke Army Medical Center, Jbsa Fort Sam Houston, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1982864179
- Provider Enumeration Date: 06/11/2008
- Last Update Date: 08/06/2025
Medicare PECOS Information:
- PECOS PAC ID: 0941429880
- Enrollment ID: I20240919003904
Medical Identifiers
Medical identifiers for Dr Stacy Lauren Coulthard such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1982864179 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | 0101246005 (Virginia) | Secondary |
| 2086S0102X | Surgery - Surgical Critical Care | MD480489 (Pennsylvania) | Secondary |
| 2086S0127X | Surgery - Trauma Surgery | MD480489 (Pennsylvania) | Secondary |
| 208600000X | Surgery | 0101246005 (Virginia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Stacy Lauren Coulthard allows following entities to bill medicare on her behalf.
| Entity Name | University Of Penn - Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1235527342
PECOS PAC ID: 6204730955
Enrollment ID: O20141111000091 |
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| Entity Name | University Of Penn - Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053447151
PECOS PAC ID: 6204730955
Enrollment ID: O20150304001436 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Stacy Lauren Coulthard is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Stacy Lauren Coulthard, MD
Brooke Army Medical Center, 3551 Roger Brooke Drive,
Jbsa Fort Sam Houston, TX 78234-4505
Ph: (210) 916-5102 | Dr Stacy Lauren Coulthard, MD
Brooke Army Medical Center, 3551 Roger Brooke Drive,
Jbsa Fort Sam Houston, TX 78234-4505
Ph: (210) 916-5102 |
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