Stacey Dimitt, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7613 Issued in KS

Practice address

1423 E Roosevelt Ave
Grants, NM 87020-2245

Phone

(505) 287-6500

Fax

(505) 287-5393

NPI assigned

Jun 14, 2011

Last updated

Sep 2, 2020By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Cibola General Hospital Corporation

  dba Cibola Family Health Center

  • Rural Health Clinic/Center
  • Grants, NM
  • NPI 1457675266

  W-2 Managing Employee

  CMS ownership

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.

• Cibola General Hospital Corporation

  dba Cibola General Hospital

  • Critical Access Hospital
  • Grants, NM
  • NPI 1780677039
  Medicare reassignment NPD
• Cibola General Hospital Corporation

  dba Cibola Family Health Center

  • Rural Health Clinic/Center
  • Grants, NM
  • NPI 1457675266

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1508151978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 E ROOSEVELT AVE",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202245",
            "telephone_number": "505-287-6500",
            "fax_number": "505-287-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 E ROOSEVELT AVE",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202245",
            "telephone_number": "505-287-6500",
            "fax_number": "505-287-5393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 E Parliament St",
            "address_purpose": "LOCATION",
            "city": "Smith Center",
            "state": "KS",
            "postal_code": "669673015",
            "country_code": "US",
            "telephone_number": "316-962-3030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "921 E Highway 36",
            "address_purpose": "LOCATION",
            "city": "Smith Center",
            "state": "KS",
            "postal_code": "66967",
            "country_code": "US",
            "telephone_number": "785-282-6834",
            "fax_number": "785-282-3793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIMITT",
        "first_name": "STACEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "7613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Grants, NM
• Providers in Grants, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.