NPIMap

Individual provider Active NPI

Stacey L. Fawbush, FNP-C

  • Family Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1104215854
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2014044284 Issued in MO
Practice address
1000 E Primrose St
Springfield, MO 65807-5154
Phone
(417) 269-9812
Fax
(417) 269-9853
NPI assigned
Jan 20, 2015
Last updated
Apr 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2014044284 MO Primary

Addresses

Primary practice location

1000 E Primrose St
Springfield, MO 65807-5154

Mailing address

PO Box 4046
Springfield, MO 65808-4046
Phone (417) 269-5712

Other identifiers 1

IdentifierTypeStateIssuer
1104215854MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150407002297 MO Practitioner - Nurse Practitioner 1254659089 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1229 E Seminole St
Springfield, MO 65804-2227
Phone (417) 820-2064

1605 Martin Springs Dr
Suite 310
Rolla, MO 65401-2980
Phone (417) 820-2064

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lester E Cox Medical Centers CurrentSince Oct 15, 2018 Accepting new patients
Lester E Cox Medical Centers Family CurrentSince May 1, 2019 Accepting new patients
Skaggs Community Hospital Association CurrentSince Aug 1, 2020 Accepting new patients
Skaggs Community Hospital Association CurrentSince Aug 1, 2020 Accepting new patients
Lester E Cox Medical Centers Current Accepting new patients
Lester E. Cox Medical Centers Current Accepting new patients
Lester E Cox Medical Centers CurrentSince Oct 15, 2018 Accepting new patients
Lester E Cox Medical Centers CurrentSince Oct 15, 2018 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

525 Branson Landing Blvd
Ste 100
Branson, MO 65616
Phone (417) 348-8646

2200 E Cleveland St
Monett, MO 65708
Phone (417) 236-2600

5100 N Towne Centre Dr
Ozark, MO 65721
Phone (417) 269-2215

1423 N Jefferson Ave
Springfield, MO 65802
Phone (417) 269-6583

2750 S Campbell Ave
Springfield, MO 65807
Phone (417) 269-2281

3801 S National Ave
Springfield, MO 65807
Phone (417) 269-4056

3801 S National Ave
Fl 5
Springfield, MO 65807

Interoperability endpoints

  • Direct secure messaging: sfawbush10970@directb.mercy.net
  • Direct secure messaging: stacey.fawbush@cernerdirect.coxhealth.com

Organizations & group practices 11

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.

Hospital & facility affiliations 12

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": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1104215854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4046",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658084046",
            "telephone_number": "417-269-5712",
            "fax_number": "417-269-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E PRIMROSE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075154",
            "telephone_number": "417-269-9812",
            "fax_number": "417-269-9853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAWBUSH",
        "first_name": "STACEY",
        "middle_name": "L.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014044284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104215854",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.