Peter John Stacy, DO is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Fairborn, Ohio. His current practice location is
2555 University Dr, Fairborn, Ohio. You can reach out to his office (for appointments etc.) via phone at
(937) 775-8148.
Peter John Stacy is licensed to practice in Missouri (license number 2022038659) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1467089888.
Physician's Profile
Full Name | Peter John Stacy |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 2555 University Dr, Fairborn, Ohio |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1467089888
- Provider Enumeration Date: 03/25/2020
- Last Update Date: 03/07/2023
Medicare PECOS Information:
- PECOS PAC ID: 7214359264
- Enrollment ID: I20200619000638
Medical Identifiers
Medical identifiers for Peter John Stacy such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1467089888 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2084P0800X | Psychiatry & Neurology - Psychiatry | 58.031688 (Ohio) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | 2022038659 (Missouri) | Primary |
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. Peter John Stacy 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 |
Peter John Stacy, DO 2555 University Dr, Fairborn, OH 45324-6255 Ph: (937) 775-8148 | Peter John Stacy, DO 2555 University Dr, Fairborn, OH 45324-6255 Ph: (937) 775-8148 |
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