Stacy Marie Smith, FNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

351434141 Issued in IN

Practice address

1310 E 7TH St., Ste J
Auburn, IN 46706

Phone

(260) 925-0305

Fax

(260) 925-6041

NPI assigned

Sep 26, 2011

Last updated

Dec 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Stacy M Robinette Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Bowen Health Inc

  dba Otis R Bowen Center

  • Adult Mental Health Clinic/Center
  • Warsaw, IN
  • NPI 1639172810
  Medicare reassignment NPD
• Mark Steven Souder, MD

  • Family Medicine Physician
  • Auburn, IN
  • NPI 1245218973
  Medicare reassignment
• Bowen Health Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Wayne, IN
  • NPI 1023668183

  Family Medicine

  NPD
• Mark S. Souder, M.D.

  • Family Medicine Physician
  • Auburn, IN
  • NPI 1922287531
  NPD (past)

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

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1407139546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 E 7TH ST STE J",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062518",
            "telephone_number": "260-925-0305",
            "fax_number": "260-925-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E 7TH ST., STE J",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "46706",
            "telephone_number": "260-925-0305",
            "fax_number": "260-925-6041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Broadway",
            "address_2": "Ste 315",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "46802",
            "country_code": "US",
            "telephone_number": "260-422-7427",
            "fax_number": "260-420-5608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-26",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28131467A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003749A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "351434141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "markssoudermd@aol.com",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "work email",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "work email",
            "address_1": "1310 E 7th St Ste J",
            "city": "Auburn",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467062518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "markssouderMD@aol.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "work email",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "work email",
            "address_1": "1310 E 7th St., Ste J",
            "city": "Auburn",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "ROBINETTE",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica L Slattery, CNP
• Zachariah John Slattery, DO
• Tammy Lynn Smart, RN
• Aimee Smith, PTA
• Savannah Smith
• Grace E. Sneary, NP
• SNH Indy Tenant LLC (Smith Farm Manor)
• Karissa Sonneberger, DPT
• Mark Steven Souder, MD
• Shirley Faith Souder, COUNSELOR

• Family Medicine Physician in Auburn, IN
• Providers in Auburn, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.