Stacy D Blum, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22314 Issued in NE

Practice address

1301 Grundman Blvd Ste a
Nebraska City, NE 68410-3320

Phone

(402) 873-4242

NPI assigned

Aug 2, 2006

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 identifiers 7

Other names 1

• Stacy D Fairbanks Former name

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Nebraska College of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Community HospitalGroup PAC ID 7113831926, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Society Home Care of Southeast NE Home health agency, Auburn, NE, CCN 287115
• Angels Care Home Health of Iowa Home health agency, Council Bluffs, IA, CCN 167292
• Angels Care Home Health Home health agency, Omaha, NE, CCN 287132
• CHI Health St Mary'S Hospital, Nebraska City, NE, CCN 281342
• CHI Health St. Elizabeth Hospital, Lincoln, NE, CCN 280020

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Mary'S Community Hospital

  • Critical Access Hospital
  • Nebraska City, NE
  • NPI 1528016995

  NE

  Medicare reassignment Care Compare group NPD
• CHI Health Clinic Specialty, LLC

  • Hospitalist Physician
  • Lincoln, NE
  • NPI 1285138065

  Family Medicine, NE

  Medicare reassignment NPD
• St. Mary'S Community Hospital

  • Rural Health Clinic/Center
  • Nebraska City, NE
  • NPI 1851737316
  Care Compare group NPD
• St. Mary'S Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Nebraska City, NE
  • NPI 1497801567
  Care Compare group
• Lincoln Physician Network LLC

  • Urgent Care Clinic/Center
  • Lincoln, NE
  • NPI 1902116833
  NPD (past)
• Mercy Health Services-Iowa Corp

  • Community/Retail Pharmacy
  • Northwood, IA
  • NPI 1316909484
  NPD (past)
• Mercy Medical Center North Iowa

  • Nurse Practitioner
  • Mason City, IA
  • NPI 1548438526
  NPD (past)

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

• Midwest Home Health Inc

  • Home Health Agency
  • Omaha, NE
  • NPI 1467582148
  Care Compare affiliation
• Saint Elizabeth Regional Medical Center

  • General Acute Care Hospital
  • Lincoln, NE
  • NPI 1336155738

  Hospital

  Care Compare affiliation
• St. Mary'S Community Hospital

  • Critical Access Hospital
  • Nebraska City, NE
  • NPI 1528016995

  Hospital

  Care Compare affiliation
• The Evangelical Lutheran Good Samaritan Society

  • Home Health Agency
  • Auburn, NE
  • NPI 1437132123
  Care Compare affiliation
• Family Touch Home Health Care, LLC

  • Home Health Agency
  • Council Bluffs, IA
  • NPI 1902805039
  Care Compare affiliation

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1174530976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 GRUNDMAN BLVD STE A",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "684103320",
            "telephone_number": "402-873-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 GRUNDMAN BLVD STE A",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "684103320",
            "telephone_number": "402-873-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 14th Ave",
            "address_purpose": "LOCATION",
            "city": "Nebraska City",
            "state": "NE",
            "postal_code": "684101146",
            "country_code": "US",
            "telephone_number": "402-873-4242",
            "fax_number": "402-873-4227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUM",
        "first_name": "STACY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "22314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025440000",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "01-06552",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLAND'S CHOICE",
            "identifier": "234550",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025323000",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7717070",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8215335",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "FAIRBANKS",
            "middle_name": "D",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Nebraska City, NE
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2018; 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.