Shelly M Staska, MD

Key facts

NPI

1114097136

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

46869 (MN)

Practice address

101 Willmar Ave SW
Willmar, MN 56201

Phone

(320) 231-5000

Fax

(320) 231-5026

NPI assigned

Nov 8, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Centracare Clinic Southwest LLC Multi-Specialty Clinic/Center · Willmar, MN · NPI 1174106264
  Medicare reassignment Care Compare group NPD MN
• Centracare Clinic Southwest LLC Durable Medical Equipment & Medical Supplies · Willmar, MN · NPI 1912664889
  Care Compare group NPD
• Bethesda Skilled Nursing Facility · Willmar, MN · NPI 1174527410
  NPD (past)

Hospital & facility affiliations 3

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

• Bethesda Skilled Nursing Facility · Willmar, MN · NPI 1174527410
  Care Compare affiliation Nursing home
• Carris Health LLC Infusion Therapy Clinic/Center · Willmar, MN · NPI 1124657150
  Care Compare affiliation Hospital
• Carris Health LLC General Acute Care Hospital · Willmar, MN · NPI 1407367030
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Family Practice

Education

University of Minnesota Medical School, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Centracare Clinic Southwest LLC (172 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centracare- Rice Memorial Hospital Hospital · Willmar, MN · CCN 240088
• Bethesda Nursing home · Willmar, MN · CCN 245427

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sstaska29827@direct.centracare.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114097136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WILLMAR AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-231-5079",
            "fax_number": "320-231-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WILLMAR AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-231-5000",
            "fax_number": "320-231-5026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASKA",
        "first_name": "SHELLY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "46869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Willmar, MN · Family Medicine Physician in Minnesota