MRS. STACEY MARIE SHOOP (M.D.) – Medical Physician Assistant, NPI 1104222124
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. STACEY MARIE SHOOP (M.D.)
11263 STONECRESS AVE
FOUNTAIN VALLEY, CA 927082448
Phone: (714) 415-8216
Type: Mailing
13095 JAMBOREE RD
TUSTIN, CA 927829150
Phone: (714) 838-8254
Type: Location
2621 S BRISTOL ST
STE 108
SANTA ANA, CA 927045718
Phone: (714) 754-1684
Fax: (714) 966-0417
Type: Mailing
11263 Stonecress Ave
Fountain Valley, CA 927082448
Phone: (714) 415-8216
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 243 Open Payments records for all available years, with a total value of $32,982.
Total Amount is formed as General ($32,982) + Research ($0) + Ownership ($0) = $32,982.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: AngioDynamics, Inc. ($19,250).
Total Amount
$32,982
General + Research + Ownership
Payments
243
Total payment records
General Amount
$32,982
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| AngioDynamics, Inc. | $19,250 |
| ZOLL Services LLC (A/K/A ZOLL LifeCor Corp) | $6,865 |
| Amgen Inc. | $1,375 |
| Medtronic, Inc. | $1,255 |
| Abbott Laboratories | $529 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-07-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190702002033 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 92708)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Vascular Surgery | TX | |
| Internal Medicine, Cardiovascular Disease (Cardiology) | CA | |
| - | CA |
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