Individual provider Active NPI

Stacy Leann Wilbanks, MD

  • Family Medicine Physician
  • Jonesboro, AR
National Provider Identifier
1336203348
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E4415 Issued in AR
Practice address
1111 Windover Rd
Jonesboro, AR 72401-6159
Phone
(870) 936-8000
Fax
(870) 336-3214
NPI assigned
Dec 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X E-4415 AR
Family Medicine Physician 207Q00000X E4415 AR Primary

Addresses

Primary practice location

1111 Windover Rd
Jonesboro, AR 72401-6159

Mailing address

PO Box 1960
Jonesboro, AR 72403-1960
Phone (870) 936-8000

Other identifiers 1

IdentifierTypeStateIssuer
166880001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050711000287 AR Practitioner - Family PracticePractitioner - Emergency MedicinePractitioner - Other (Physician) 2466488663 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Arkansas Clinic Charitable Foundation, Inc.Group PAC ID 2961547526, 294 clinicians

Practice addresses (Care Compare)

1111 Windover Rd
Jonesboro, AR 72401-6159
Phone (870) 935-5432

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-8000

4802 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-8000

4808 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-8000

Hospital & facility affiliations

  • Baptist Memorial Hospital Jonesboro, Inc. Hospital, Jonesboro, AR, CCN 040118

Merit-based Incentive Payment System (MIPS)

Final score
75.65 of 100Reported as group
Quality
44.87
Promoting interoperability
100
Improvement activities
40
Cost
73.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue171
Removal of skin lesions22
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E4415ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Bernards Hospital Inc CurrentSince May 2, 2017 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jun 1, 2011 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jun 1, 2011 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
North Central Arkansas Medical Associates Family Medicine Past Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Piggott Community Hospital Past Accepting new patients

Locations

909 Enterprise Dr
Jonesboro, AR 72401
Phone (870) 336-1100

303 E Matthews Ave
Ste 202
Jonesboro, AR 72401
Phone (870) 207-7555

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

225 E Jackson Ave
Jonesboro, AR 72401
Phone (870) 207-1630

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.532

Organizations & group practices 8

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": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1336203348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-336-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 WINDOVER RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016159",
            "telephone_number": "870-936-8000",
            "fax_number": "870-336-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBANKS",
        "first_name": "STACY",
        "middle_name": "LEANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-4415",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E4415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166880001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.