Active NPI
Stacy L Jansen, M.D.
- Family Medicine Physician
- Anderson, MO
National Provider Identifier
1104821883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2000156458
- Practice address
- 510 Park St
Anderson, MO 64831-9280 - Phone
- (417) 845-0545
- Fax
- (417) 845-0548
- NPI assigned
- Jun 17, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2000156458 | MO | Primary |
Addresses
Primary practice location
510 Park St
Anderson, MO 64831-9280
Mailing address
PO Box 3810
Joplin, MO 64803-3810
Phone (417) 845-0545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00279800 | Other | RR MEDICARE | |
| 129295 | Other | MO | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1104821883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3810",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648033810",
"telephone_number": "417-845-0545",
"fax_number": "417-845-0548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 PARK ST",
"city": "ANDERSON",
"state": "MO",
"postal_code": "648319280",
"telephone_number": "417-845-0545",
"fax_number": "417-845-0548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANSEN",
"first_name": "STACY",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-17",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2000156458",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00279800",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "129295",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anderson, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.