Individual provider Active NPI

Stacey Leigh Coon-Walsh, CRNP

  • Nurse Practitioner
  • Johnson City, NY
National Provider Identifier
1376949941
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
310143 Issued in NY
Practice address
30 Harrison St Ste 400
Johnson City, NY 13790-2176
Phone
(607) 763-8008
Fax
(607) 763-8019
NPI assigned
Nov 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP014441 PA
Nurse Practitioner 363L00000X 310143 NY Primary

Addresses

Primary practice location

30 Harrison St Ste 400
Johnson City, NY 13790-2176

Mailing address

33 Lewis Rd
2ND FL
Binghamton, NY 13905
Phone (607) 770-0025

Other names 1

  • Stacey Leigh Coon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210125000111 NY Practitioner - Nurse Practitioner 6709100076 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Medical Associates PCGroup PAC ID 0345144978, 229 clinicians

Practice addresses (Care Compare)

33 -57 Harrison St
Johnson City, NY 13790-2107
Phone (607) 763-6412

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.59 of 100Reported as group
Quality
78.3
Promoting interoperability
100
Improvement activities
40
Cost
72.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
310143NYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Associates, P.C. CurrentSince Aug 9, 2021 Accepting new patients
United Health Services Hospitals, Inc. CurrentSince Jan 25, 2021 Accepting new patients
United Medical Associates PC CurrentSince Aug 9, 2021 Accepting new patients

Locations

33 Lewis Rd
Ste 2
Binghamton, NY 13905

33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156

30 Harrison St
Ste 400
Johnson City, NY 13790
Phone (607) 763-8008

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

Interoperability endpoints

  • Direct secure messaging: scoonwalsh5531@direct-guthrie.org

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 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": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1376949941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LEWIS RD",
            "address_2": "2ND FL",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "13905",
            "telephone_number": "607-770-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HARRISON ST STE 400",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902176",
            "telephone_number": "607-763-8008",
            "fax_number": "607-763-8019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COON-WALSH",
        "first_name": "STACEY",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP014441",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "310143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "COON",
            "middle_name": "LEIGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.