Susan Stacker

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

4828 Issued in WI

Practice address

1220 N 6 Street
Wausau, WI 54401-1220

Phone

(715) 845-7759

Fax

(715) 845-4509

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 21, 2016 through Sep 21, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Susan Stacker DDS SC

  • Periodontics
  • Wausau, WI
  • NPI 1497819585
  NPD (past) Authorized official
• Advanced Dental Specialists, LLC

  • General Practice Dentistry
  • Glendale, WI
  • NPI 1497403398
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1306903786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 N 6 STREET",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544031220",
            "telephone_number": "715-845-7759",
            "fax_number": "715-845-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N 6 STREET",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544011220",
            "telephone_number": "715-845-7759",
            "fax_number": "715-845-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKER",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "4828",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "4828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calvin D. Sprik, M.D.
• Spring Into Life Chiropractic, LLC
• Tracy Denise Springer, SAC
• Ashley E St Clair, NP
• Maunee St. Germaine, PTA
• Samuel Staehling
• Todd Arthur Stage, LCSW
• Debra Stahl, M.A.
• Justin Lee Stangl, MSE, LPC
• Randy J Stank, CRNA

• Periodontics in Wausau, WI
• Providers in Wausau, WI by specialty
• Periodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.