Individual provider Active NPI

Stacie Woods

  • Medical Physician Assistant
  • Salem, OR
National Provider Identifier
1184071680
Registry record updated Jan 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1585 Liberty St SE
Salem, OR 97302-4345
Phone
(503) 589-0463
Fax
(503) 589-0463
NPI assigned
May 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

1585 Liberty St SE
Salem, OR 97302-4345

Mailing address

PO Box 702
McCall, ID 83638-0702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20200513001527 ID Practitioner - Physician Assistant 8729346523 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Washington School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1226 W River St
Boise, ID 83702-7049
Phone (208) 331-1155

403 S 11TH St
Boise, ID 83702-6968

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • St Luke'S Elmore Medical Center Hospital, Mountain Home, ID, CCN 131311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Mar 24, 2020 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

403 S 11th St
Ste 100
Boise, ID 83702
Phone (208) 429-0300

1226 W River St
Boise, ID 83702
Phone (208) 331-1155

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

Interoperability endpoints

  • Direct secure messaging: swoods170192@direct.slhs.org

Organizations & group practices 2

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 5

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": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515974400000",
    "number": "1184071680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 702",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836380702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024345",
            "telephone_number": "503-589-0463",
            "fax_number": "503-589-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODS",
        "first_name": "STACIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-16",
        "last_updated": "2018-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.