NPIMap

Individual provider Active NPI

Stacy Lamae Van Sambeek, PA

  • Physician Assistant
  • Neenah, WI
National Provider Identifier
1366824179
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3579 Issued in WI
Practice address
130 2ND St
Neenah, WI 54956-2883
Phone
(920) 725-0077
Fax
(920) 725-6535
NPI assigned
Jun 29, 2015
Last updated
May 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3579 WI Primary

Addresses

Primary practice location

130 2ND St
Neenah, WI 54956-2883

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3200

Other practice location 1

820 E Grant St
Appleton, WI 54911-3483
Phone (920) 831-5050

Other names 1

  • Stacy Lamae Backen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20150731016709 WI Practitioner - Physician Assistant 2365756574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

130 2ND St
Neenah, WI 54956-2883
Phone (920) 725-0077

2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 720-2300

3 Neenah Ctr
Neenah, WI 54956-3070

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

520 W 3Rd St
Kimberly, WI 54136-1300
Phone (920) 788-7680

600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 725-0077

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3579WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jul 13, 2015 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

1818 N Meade St
Ste N347
Appleton, WI 54911
Phone (920) 225-1449

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: sbacken32116@direct.thedacare.org

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1366824179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-996-3200",
            "fax_number": "920-725-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562883",
            "telephone_number": "920-725-0077",
            "fax_number": "920-725-6535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 E Grant St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113483",
            "country_code": "US",
            "telephone_number": "920-831-5050",
            "fax_number": "920-725-6535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN SAMBEEK",
        "first_name": "STACY",
        "middle_name": "LAMAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "BACKEN",
            "middle_name": "LAMAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.