NPIMap

Individual provider Active NPI

Stacia Kristine Shimanek, PA

  • Physician Assistant
  • Kalispell, MT
National Provider Identifier
1437429388
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-113123 Issued in MT
Practice address
200 Commons Way Ste B
Kalispell, MT 59901-1915
Phone
(406) 752-5170
Fax
(406) 752-5210
NPI assigned
Jan 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA2019-0026 NM
Physician Assistant 363A00000X MED-PAC-LIC-113123 MT Primary

Addresses

Primary practice location

200 Commons Way Ste B
Kalispell, MT 59901-1915

Mailing address

1640 Old Pecos TRL Ste H
Santa Fe, NM 87505-4777
Phone (505) 992-0233

Other practice location 1

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone (505) 272-6040

Other practice location 2

1640 Old Pecos Trl Ste H
Santa Fe, NM 87505-4777
Phone (505) 992-0233

Other identifiers 1

IdentifierTypeStateIssuer
869N70OtherTXBCBSTX

Other names 1

  • Stacia Sunderland Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20220815001359 MT Practitioner - Physician Assistant 3971763178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 Commons Way
Kalispell, MT 59901-1915

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6725

320 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 756-3526

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-113123MTMDPhysician Assistant
PA2019-0026NMMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Jul 27, 2022 Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Jul 27, 2022 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients
MHS Physicians of Texas Past Accepting new patients

Locations

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

200 Commons Way
Ste B
Kalispell, MT 59901
Phone (406) 752-5170

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org
  • Direct secure messaging: sshimanek197416@direct.tmfhs.org

Organizations & group practices 6

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 9

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": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1437429388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 OLD PECOS TRL STE H",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054777",
            "telephone_number": "505-992-0233",
            "fax_number": "505-992-0609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COMMONS WAY STE B",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599011915",
            "telephone_number": "406-752-5170",
            "fax_number": "406-752-5210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 Lomas Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871062719",
            "country_code": "US",
            "telephone_number": "505-272-6040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1640 Old Pecos Trl Ste H",
            "address_purpose": "LOCATION",
            "city": "Santa Fe",
            "state": "NM",
            "postal_code": "875054777",
            "country_code": "US",
            "telephone_number": "505-992-0233",
            "fax_number": "505-992-0609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIMANEK",
        "first_name": "STACIA",
        "middle_name": "KRISTINE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-10",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2019-0026",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-113123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "869N70",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "200 Commons Way Ste B",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599011915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACIA",
            "last_name": "SUNDERLAND",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.