Individual provider Active NPI

Stacy Marie Cantwell

  • Adult Health Nurse Practitioner
  • Chandler, AZ
National Provider Identifier
1164760245
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
AP8669 Issued in AZ
Practice address
485 S Dobson Rd Ste 201
Chandler, AZ 85224-5604
Phone
(480) 728-4728
Fax
(480) 728-4747
NPI assigned
Jan 23, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP8669 AZ Primary
Acute Care Nurse Practitioner 363LA2100X 22570 CA

Addresses

Primary practice location

485 S Dobson Rd Ste 201
Chandler, AZ 85224-5604

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

1955 W Frye Rd
Chandler, AZ 85224-6282
Phone (480) 728-4700

Other names 1

  • Stacy Marie Shelton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20160921000146 AZ Practitioner - Nurse Practitioner 6305082629 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Indiana Medical College, School of Medicine of Purdue University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chandler Regional Medical CenterGroup PAC ID 5395729784, 52 clinicians
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

1955 W Frye Rd
Chandler, AZ 85224-6282
Phone (480) 728-4700

500 W Thomas Rd
680 DHMG St Joseph'S Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sjhmc Physician Services CurrentSince Aug 8, 2016 Accepting new patients
St. Joseph'S Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
Dignity Community Care Past Accepting new patients
Livi Medical Services LLC PastSince Aug 26, 2024 Accepting new patients

Locations

485 S Dobson Rd
Ste 201
Chandler, AZ 85224
Phone (480) 728-4700

1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961

1501 N Gilbert Rd
Gilbert, AZ 85234
Phone (480) 503-5400

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

3030 N Central Ave
Ste 1001
Phoenix, AZ 85012

File 56765
Los Angeles, CA 90074

Organizations & group practices 5

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 1

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": "1358899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1164760245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 S DOBSON RD STE 201",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245604",
            "telephone_number": "480-728-4728",
            "fax_number": "480-728-4747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1955 W Frye Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852246282",
            "country_code": "US",
            "telephone_number": "480-728-4700",
            "fax_number": "480-728-4747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANTWELL",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-23",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "AP8669",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "22570",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "SHELTON",
            "middle_name": "MARIE",
            "credential": "ACNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.