NPIMap

Individual provider Active NPI

Stacy Chang, MSN, APRN, CNP

  • Family Nurse Practitioner
  • Brooklyn Center, MN
National Provider Identifier
1245896919
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
6457 Issued in MN
Practice address
6200 Shingle Creek Pkwy Ste 260
Brooklyn Center, MN 55430-2128
Phone
(763) 544-0696
NPI assigned
May 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 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 6457 MN Primary

Addresses

Primary practice location

6200 Shingle Creek Pkwy Ste 260
Brooklyn Center, MN 55430-2128

Mailing address

6200 Shingle Creek Pkwy Ste 260
Brooklyn Center, MN 55430-2128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20190624001865 MN Practitioner - Nurse Practitioner 0042544132 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Specialists of Minnesota, PAGroup PAC ID 5092616029, 33 clinicians

Practice addresses (Care Compare)

6601 Lyndale Ave S
Suite 220
Richfield, MN 55423-2493
Phone (612) 823-8001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Specialists of Minnesota, PA CurrentSince Jan 4, 2023 Accepting new patients
Ilbnc, P.a. PastSince Jan 4, 2023 Accepting new patients

Locations

6200 Shingle Creek Pkwy
Ste 250
Minneapolis, MN 55430
Phone (612) 823-8001

6200 Shingle Creek Pkwy
Ste 260
Minneapolis, MN 55430
Phone (763) 544-0696

6601 Lyndale Ave S
Ste 220
Richfield, MN 55423
Phone (612) 823-8001

2085 Rice St
Saint Paul, MN 55113
Phone (651) 489-9035

Interoperability endpoints

  • Direct secure messaging: schang47823@direct.acumenmd.com

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 and National Provider Directory roles.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1245896919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY STE 260",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY STE 260",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302128",
            "telephone_number": "763-544-0696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "STACY",
        "credential": "MSN, APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-17",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "6457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

Verify at the official NPI Registry.