Stacey M Boswell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10001506A Issued in IN

Practice address

11141 Parkview Plaza Dr Ste 305
Fort Wayne, IN 46845-1715

Phone

(260) 266-8900

Fax

(260) 266-8935

NPI assigned

Mar 15, 2013

Last updated

Dec 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stacey Marie Sudhoff Former name

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Merit-based Incentive Payment System (MIPS)

Final score

83.53 of 100Reported as group

Quality

70

Promoting interoperability

100

Improvement activities

40

Cost

75.11

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sboswell65736@direct.parkviewexchange.com

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.

• Parkview Health System Inc

  dba Parkview Physicians Group

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment Care Compare group NPD
• Associated Surgeons and Physicians, LLC

  • Foot & Ankle Surgery Podiatrist
  • Auburn, IN
  • NPI 1649720301
  NPD (past)
• Indiana Surgical Specialists, LLC

  • Surgery Physician
  • Fort Wayne, IN
  • NPI 1528044625
  NPD (past)

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

• Parkview Hospital, Inc.

  dba Parkview Regional Medical Center

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1114268125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 305",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451715",
            "telephone_number": "260-266-8900",
            "fax_number": "260-266-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSWELL",
        "first_name": "STACEY",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-15",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001506A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sboswell65736@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 305",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451715",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 305",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451715",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 305",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "SUDHOFF",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bosley Enterprises LLC
• Raphael Bosley, LMHC
• Melissa Sue Bosma, MD
• Samuel Thomas Boston, M.D.
• Benjamin Boswell, DDS
• Vaneska Bottino Da Costa, M.D.
• Sarah Botts, PT, DPT
• Stephanie Botts, MBA, LAT, ACT
• Paige Boughan
• Bryan Treffley Bourcier, DPT

• Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.