Individual provider Active NPI

Christopher J Stacey, P.A.-C

  • Medical Physician Assistant
  • Bellingham, WA
National Provider Identifier
1407959463
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10004130 Issued in WA
Practice address
2940 Squalicum Pkwy
#203
Bellingham, WA 98225-1892
Phone
(360) 733-0640
Fax
(360) 733-1034
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10004130 WA Primary

Addresses

Primary practice location

2940 Squalicum Pkwy
#203
Bellingham, WA 98225-1892

Mailing address

2940 Squalicum Pkwy Ste 203
Bellingham, WA 98225-1892
Phone (360) 738-3223

Other identifiers 1

IdentifierTypeStateIssuer
8353880MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20050209000120 WA Practitioner - Physician Assistant 2668423484 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2940 Squalicum Pkwy
Suite 203
Bellingham, WA 98225-1892
Phone (360) 733-0640

Merit-based Incentive Payment System (MIPS)

Final score
90.31 of 100Reported as group
Quality
80.61
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10004130WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Oct 1, 2010 Accepting new patients

Locations

2901 Squalicum Pkwy
Bellingham, WA 98225
Phone (360) 734-5400

3015 Squalicum Pkwy
Ste 100
Bellingham, WA 98225
Phone (360) 715-4186

Interoperability endpoints

  • Direct secure messaging: cstacey2475141@wm.providencedirect.org

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1407959463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 SQUALICUM PKWY STE 203",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251892",
            "telephone_number": "360-738-3223",
            "fax_number": "360-733-1034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 SQUALICUM PKWY",
            "address_2": "#203",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251892",
            "telephone_number": "360-733-0640",
            "fax_number": "360-733-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACEY",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8353880",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

Verify at the official NPI Registry.