Staci Jeanne Sides, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71006609A Issued in IN

Practice address

400 N Mount Zion Rd
Lebanon, IN 46052-9497

Phone

(765) 335-0123

Fax

(765) 335-0127

NPI assigned

Sep 22, 2016

Last updated

Jul 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Witham Memorial HospitalGroup PAC ID 4082523170, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Witham Health Services Hospital, Lebanon, IN, CCN 150104

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Witham Memorial Hospital

  dba Witham Health Services

  • Family Medicine Physician
  • Lebanon, IN
  • NPI 1083750293
  Medicare reassignment Care Compare group NPD
• Witham Memorial Hospital

  dba Witham Rehabilitation Services, Anson at Whitestown

  • Physical Therapist
  • Zionsville, IN
  • NPI 1952282204
  NPD
• Johnson Memorial Hospital

  dba Todd Aikens Acute Rehab Care

  • Rehabilitation Hospital Unit
  • Franklin, IN
  • NPI 1255331104
  NPD (past)

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

• Witham Memorial Hospital

  dba Witham Health Services

  • General Acute Care Hospital
  • Lebanon, IN
  • NPI 1699757401
  Care Compare affiliation

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1023567823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 305",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MOUNT ZION RD",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460529497",
            "telephone_number": "765-335-0123",
            "fax_number": "765-335-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDES",
        "first_name": "STACI",
        "middle_name": "JEANNE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-22",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006609A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201403450",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "staci.sides@whs.eclinicaldirectplus.com",
            "affiliation": "Y",
            "affiliationName": "Witham Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "400 N Mount Zion Rd",
            "city": "Lebanon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460529497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lyndsie Shepherd
• Jada Shields-Price, RBT
• Haley Ann Shirley, NP
• Rachel Short
• Allison Rae Shrack
• Monique Simpson-Pontious, RBT
• Mona Singh, MD
• Stephanie Skinner, RN
• Jeremy Slager
• Jessica L Smith, LCSW

• Family Nurse Practitioner in Lebanon, IN
• Providers in Lebanon, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.