Individual provider Active NPI

Stacy D Menees, FNP

  • Family Nurse Practitioner
  • Centralia, IL
National Provider Identifier
1386815959
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209007026 Issued in IL
Practice address
432 N Pleasant Ave
Centralia, IL 62801-3006
Phone
(618) 436-8300
NPI assigned
Mar 21, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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 209007026 IL Primary

Addresses

Primary practice location

432 N Pleasant Ave
Centralia, IL 62801-3006

Mailing address

PO Box 955860
Saint Louis, MO 63195-3988
Phone (636) 498-5944

Other practice location 1

900 Logan College Road
Carterville, IL 62918
Phone (618) 956-9202

Other names 1

  • Stacy D Gardner Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address smenees333986@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080730000075 IL Practitioner - Nurse Practitioner 6103990841 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Dec 14, 2019 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Oct 27, 2019 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Oct 27, 2019 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois Current Accepting new patients
Stacy Gardner Family PastSince Jan 1, 1990 Accepting new patients

Locations

432 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5200

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

Interoperability endpoints

  • Direct secure messaging: smenees14012@sih.direct-ci.com
  • Direct secure messaging: smenees333986@direct-ehr-ssmhc.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1386815959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955860",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631953988",
            "telephone_number": "636-498-5944",
            "fax_number": "618-529-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013006",
            "telephone_number": "618-436-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Logan College Road",
            "address_purpose": "LOCATION",
            "city": "Carterville",
            "state": "IL",
            "postal_code": "62918",
            "country_code": "US",
            "telephone_number": "618-956-9202",
            "fax_number": "618-956-9202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENEES",
        "first_name": "STACY",
        "middle_name": "D",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-21",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209007026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smenees333986@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "smenees333986@direct-ehr-ssmhc.com",
            "address_1": "432 N Pleasant Ave",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628013006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "432 N Pleasant Ave",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628013006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "GARDNER",
            "middle_name": "D",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.