Stacey Marie Burdett, FNP-BC
Individual provider Active NPI Nurse Practitioner · Ronan, MT
NPI 1073208757 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1073208757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 214369 (MT)
- Practice address
- 126 6TH Ave SW
Ronan, MT 59864-2600 - Phone
- (406) 676-3600
- Fax
- (406) 676-3738
- NPI assigned
- Apr 7, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Lukes Community Hospital
Practice addresses (Care Compare)
126 6TH Ave SW
Ronan, MT 59864-2600
Phone (406) 676-3600
Hospital & facility affiliations
- Partners in Home Care Inc
- St Luke Community Hospital
- Community Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231218003621 | MT | Practitioner - Nurse Practitioner | 1052777521 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75899 | ID | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Community Hospital | Current |
Accepting new patients | |
| St Lukes Community Hospital | Current |
Accepting new patients | |
| St. Lukes Community Hospital | Current | Accepting new patients | |
| St. Lukes Community Hospital | Past | Accepting new patients |
Locations
126 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600
107 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600
126 6th Ave SW
Ste A
Ronan, MT 59864
Phone (406) 676-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 75899 | ID | |
| Nurse Practitioner | 363L00000X | 214369 | MT | Yes |
Addresses
Primary practice location
126 6TH Ave SW
Ronan, MT 59864-2600
Mailing address
42543 Park Circle Dr
Polson, MT 59860-7533
Phone (406) 360-4263
Other practice location 1
330 6 Tracts Way
St Ignatius, MT 59865-7784
Phone (406) 745-2781
Other providers in Ronan, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.