Individual provider Active NPI

Stacie R. Johnson, APRN

  • Family Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1205212677
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
111879 Issued in NE
Practice address
7710 Mercy Rd Ste 3000
Omaha, NE 68124-2350
Phone
(402) 717-9600
Fax
(402) 717-6014
NPI assigned
Aug 7, 2015
Last updated
Apr 27, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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 111879 NE Primary

Addresses

Primary practice location

7710 Mercy Rd Ste 3000
Omaha, NE 68124-2350

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (402) 398-6248

Other names 1

  • Stacie R. Mahoney Former name

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150814013481 NE Practitioner - Nurse Practitioner 0042525396 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pain Centers of the Midlands LLCGroup PAC ID 1658680020, 5 clinicians

Practice addresses (Care Compare)

13340 California St
Suite 101
Omaha, NE 68154-5255
Phone (402) 614-1999

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111879NEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Glenn J Bricken & Assoc P C CurrentSince Jan 16, 2024 Accepting new patients
Pain Centers of the Midlands LLC CurrentSince Jul 1, 2019 Accepting new patients
Neurology Consultants of Nebraska PC PastSince Jul 1, 2024 Accepting new patients

Locations

12702 Westport Pkwy
Ste 101
Omaha, NE 68138
Phone (402) 226-8808

13340 California St
Ste 101
Omaha, NE 68154
Phone (402) 614-1999

13340 California St
Ste 201
Omaha, NE 68154
Phone (402) 614-1999

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12153/brand/1/csg/1/fhir/r4
  • Direct secure messaging: stacie.johnson.2@12153.direct.athenahealth.com

Organizations & group practices 4

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 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": "1438905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524787200000",
    "number": "1205212677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "402-398-6248",
            "fax_number": "402-829-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 3000",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242350",
            "telephone_number": "402-717-9600",
            "fax_number": "402-717-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACIE",
        "middle_name": "R.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-07",
        "last_updated": "2018-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "111879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIE",
            "last_name": "MAHONEY",
            "middle_name": "R.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.