Individual provider Active NPI

Stacy Lynn McIntyre, CRNA

  • Certified Registered Nurse Anesthetist
  • Tacoma, WA
National Provider Identifier
1235496407
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP60270648 Issued in WA
Practice address
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone
(253) 596-3300
Fax
(253) 596-3301
NPI assigned
Apr 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP60270648 WA Primary

Addresses

Primary practice location

209 Martin Luther King Jr Way
Tacoma, WA 98405-4265

Mailing address

3900 Capitol Mall Dr SW
Olympia, WA 98502-8654
Phone (954) 838-2588

Other practice location 1

1613 Harrison Pkwy
Suite 200, Bldg. C
Sunrise, FL 33323-2896
Phone (954) 838-2588

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120529000092 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264695469 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

2811 Tieton Dr
Yakima, WA 98902-3761
Phone (509) 575-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP60270648WAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Jun 19, 2019 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Sep 15, 2019 Accepting new patients
Olympia Multi Specialty Clinic CurrentSince Oct 1, 2019 Accepting new patients
Public Hospital District No 1 of Mason County Nurse Anesthetist, Certified Registered CurrentSince Sep 15, 2019 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Nov 22, 2022 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Nov 22, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jun 19, 2019 Accepting new patients
Tahoma Anesthesiology Consultants PS Past Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

406 Black Hills Ln SW
Ste A
Olympia, WA 98502
Phone (360) 754-1727

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

901 Mountain View Dr
Bldg 1
Shelton, WA 98584
Phone (360) 426-1611

209 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 596-3300

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Organizations & group practices 9

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 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": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1235496407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 CAPITOL MALL DR SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028654",
            "telephone_number": "954-838-2588",
            "fax_number": "954-514-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MARTIN LUTHER KING JR WAY",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054265",
            "telephone_number": "253-596-3300",
            "fax_number": "253-596-3301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 Harrison Pkwy",
            "address_2": "Suite 200, Bldg. C",
            "address_purpose": "LOCATION",
            "city": "Sunrise",
            "state": "FL",
            "postal_code": "333232896",
            "country_code": "US",
            "telephone_number": "954-838-2588",
            "fax_number": "954-514-3979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCINTYRE",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-12",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60270648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "209 Martin Luther King Jr Way",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.