NPIMap

Individual provider Active NPI

Stacy Richardson, RN,MSN,FNP-C

  • Family Nurse Practitioner
  • Charleston, WV
National Provider Identifier
1184862096
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
44522 Issued in WV
Practice address
3100 Maccorkle Ave SE Ste 900
Charleston, WV 25304-1223
Phone
(304) 388-5880
Fax
(304) 388-5858
NPI assigned
Jan 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 44522 WV Primary

Addresses

Primary practice location

3100 Maccorkle Ave SE Ste 900
Charleston, WV 25304-1223

Mailing address

400 Association Dr Ste 102
Charleston, WV 25311-1298
Phone (304) 388-0151

Other practice location 1

3100 MacCorkle Ave
Suite 700
Charleston, WV 25304-1223
Phone (304) 347-1204

Other practice location 2

3200 MacCorkle Avenue, SE
Charleston, WV 25304
Phone (304) 388-5432

Other identifiers 1

IdentifierTypeStateIssuer
3810014885MedicaidWV

Other names 1

  • Stacy J Groom Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090527000645 WV Practitioner - Nurse Practitioner 5193873123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Maccorkle Ave SE
Suite 900
Charleston, WV 25304-1223
Phone (304) 388-5880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Jun 1, 2018 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Jun 1, 2018 Accepting new patients
Kanawha Valley Heart Specialists Past Accepting new patients

Locations

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

3200 Maccorkle Ave SE
#C
Charleston, WV 25304
Phone (304) 347-1336

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

3100 Maccorkle Ave SE
Ste 700
Charleston, WV 25304
Phone (304) 351-1500

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

4610 Kanawha Ave SW
Ste 200
South Charleston, WV 25309
Phone (304) 205-7992

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1184862096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 ASSOCIATION DR STE 102",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111298",
            "telephone_number": "304-388-0151",
            "fax_number": "304-388-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 900",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041223",
            "telephone_number": "304-388-5880",
            "fax_number": "304-388-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 MacCorkle Ave",
            "address_2": "Suite 700",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041223",
            "country_code": "US",
            "telephone_number": "304-347-1204",
            "fax_number": "304-347-1259",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3200 MacCorkle Avenue, SE",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "25304",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "STACY",
        "credential": "RN,MSN,FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "44522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810014885",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "GROOM",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.