Individual provider Active NPI

Stephanie Willet, M.D.

  • Anesthesiology Physician
  • Minot, ND
National Provider Identifier
1023375292
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
14725 Issued in ND
Practice address
1 Burdick Expy W
Minot, ND 58701-4406
Phone
(701) 857-5124
NPI assigned
Apr 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 14725 ND Primary

Addresses

Primary practice location

1 Burdick Expy W
Minot, ND 58701-4406

Mailing address

11645 Vixens Path
Ellicott City, MD 21042-1541
Phone (410) 404-2881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201208001641 AK Practitioner - Anesthesiology 6709151699 Reassigns benefits to 1 organization
I20241031002634 NJ Practitioner - Anesthesiology 6709151699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of South Florida College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Practice addresses (Care Compare)

1650 Cowles St
Fairbanks, AK 99701-5907
Phone (907) 459-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.86 of 100Reported as group
Quality
94.88
Promoting interoperability
100
Improvement activities
40
Cost
79.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14725NDMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Healthcare Specialists PC Anesthesiology CurrentSince Oct 1, 2024 Accepting new patients
Tanana Valley Clinic LLC CurrentSince Oct 1, 2020 Accepting new patients
Tanana Valley Clinic LLC CurrentSince Oct 1, 2020 Accepting new patients

Locations

1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181

1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1023375292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 VIXENS PATH",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210421541",
            "telephone_number": "410-404-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BURDICK EXPY W",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014406",
            "telephone_number": "701-857-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLET",
        "first_name": "STEPHANIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ND",
            "license": "14725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.