Staci Lynn Burleyson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209017646 Issued in IL

Practice address

1275 Hawthorn Rd
Salem, IL 62881-1028

Phone

(618) 548-4545

Fax

(618) 548-4577

NPI assigned

Mar 27, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Illinois Healthcare Foundation IncGroup PAC ID 1456256874, 117 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• LHC-Illinois Home Health Care Home health agency, Marion, IL, CCN 147716
• Salem Township Hospital Hospital, Salem, IL, CCN 141345
• SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: staci.burleyson.1@9559.direct.athenahealth.com

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.

• Southern Illinois Healthcare Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Southern Illinois Healthcare Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Good Samaritan Regional Health Center

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• LHCG Xxxvii, LLC

  • Home Health Agency
  • Marion, IL
  • NPI 1740527407
  Care Compare affiliation
• Salem Township Hospital

  • Critical Access Hospital
  • Salem, IL
  • NPI 1295739548
  Care Compare affiliation
• St Mary'S Hospital, Centralia, Illinois

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1487159943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 HAWTHORN RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628811028",
            "telephone_number": "618-548-4545",
            "fax_number": "618-548-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 HAWTHORN RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628811028",
            "telephone_number": "618-548-4545",
            "fax_number": "618-548-4577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURLEYSON",
        "first_name": "STACI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "F03180485",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "staci.burleyson.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ccd",
            "address_1": "1275 Hawthorn Rd",
            "city": "Salem",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628811028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie D Branch, APN
• Janet L. Broom, MSN, APRN-BC
• Amber S Bruce, APRN, FNP-C
• Jessica Linn Bryan
• Lou B Bryant, PH.D
• Katie Jeannine Burmeister, D.C.
• Tracy Adele Caswell, APRN
• Quinn Kun Chen, DDS
• Kyle Allen Clark, D.M.D.
• Danielle Nichole Cole, RBT

• Family Nurse Practitioner in Salem, IL
• Providers in Salem, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.