Active NPI
Phyllis J. Stout, FNP
- Family Nurse Practitioner
- Springfield, MO
National Provider Identifier
1457496895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 052911
- Practice address
- 2115 S Fremont Ave
Suite 1000
Springfield, MO 65804-2239 - Phone
- (417) 820-8099
- Fax
- (417) 820-8093
- NPI assigned
- Feb 21, 2007
- Last updated
- Nov 18, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 052911 | MO | Primary |
Addresses
Primary practice location
2115 S Fremont Ave
Suite 1000
Springfield, MO 65804-2239
Mailing address
PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431560263 | Other | TRICARE WEST | |
| 171792758 | Medicaid | AR | |
| 429683519 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Springfield | Past | Accepting new patients | |
| Ozarks Medical Center | Past | Accepting new patients |
Interoperability endpoints
- pstout826@directb.mercy.net
Organizations & group practices 2
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.
-
- Medicare Defined Swing Bed Hospital Unit
- Springfield, MO
- NPI 1053907113
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226966400000",
"number": "1457496895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2580",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658012580",
"telephone_number": "417-829-4620",
"fax_number": "417-829-4316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 S FREMONT AVE",
"address_2": "SUITE 1000",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042239",
"telephone_number": "417-820-8099",
"fax_number": "417-820-8093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "PHYLLIS",
"middle_name": "J.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2008-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "052911",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WEST",
"identifier": "431560263",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "171792758",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "429683519",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.