Individual provider Active NPI

Stacey Wright Eaves, ACNP

  • Acute Care Nurse Practitioner
  • Bossier City, LA
National Provider Identifier
1104172535
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP07073 Issued in LA
Practice address
2300 Hospital Dr
Ste. 450
Bossier City, LA 71111-2394
Phone
(318) 752-2328
Fax
(318) 746-0160
NPI assigned
Aug 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP07073 LA Primary

Addresses

Primary practice location

2300 Hospital Dr
Ste. 450
Bossier City, LA 71111-2394

Mailing address

2300 Hospital Dr
Ste. 450
Bossier City, LA 71111-2394
Phone (318) 752-2328

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20121010000370 LA Practitioner - Nurse Practitioner 8022267830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WKMC Cardiovascular ConsultantsGroup PAC ID 0941420061, 34 clinicians

Practice addresses (Care Compare)

2727 Hearne Ave
Suite 301
Shreveport, LA 71103-3918
Phone (318) 631-6400

Hospital & facility affiliations

  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Merit-based Incentive Payment System (MIPS)

Final score
91.53 of 100Reported as apm
Quality
81.42
Promoting interoperability
94.6
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP07073LAMDAcute Care Nurse Practitioner

Organizations & group practices 1

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 4

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": "1343952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1104172535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "STE. 450",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-752-2328",
            "fax_number": "318-746-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "STE. 450",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-752-2328",
            "fax_number": "318-746-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAVES",
        "first_name": "STACEY",
        "middle_name": "WRIGHT",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-03",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "AP07073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.