Mira F. Staco, N.P.P. A.N.P.

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

401229 Issued in NY

Practice address

819 University St
Valley Stream, NY 11581-3517

Phone

(516) 569-0887

Fax

(516) 569-0887

NPI assigned

Oct 8, 2009

Last updated

Nov 14, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

State University of New York at Stony Brook, School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St. Vincent's Services IncGroup PAC ID 7012808793, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mira.staco@direct.heartshare.nextgenshare.com
• Direct secure messaging: mira.stacopmhnpbc.p3@direct.heartshare.nextgenshare.com

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.

• St. Vincent's Services, Inc.

  • Foster Care Agency
  • Brooklyn, NY
  • NPI 1003015694
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384387200000",
    "number": "1235464298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 UNIVERSITY ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115813517",
            "telephone_number": "516-569-0887",
            "fax_number": "516-569-0887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 UNIVERSITY ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115813517",
            "telephone_number": "516-569-0887",
            "fax_number": "516-569-0887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACO",
        "first_name": "MIRA",
        "middle_name": "F.",
        "name_prefix": "Mrs.",
        "credential": "N.P.P. A.N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-08",
        "last_updated": "2013-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F306665",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.