Individual provider Active NPI

Stacy Ann Kretzer, MSW

  • Clinical Social Worker
  • Jefferson City, MO
National Provider Identifier
1518151117
Registry record updated Mar 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2007017187 Issued in MO
Practice address
1432 Southwest Blvd
Jefferson City, MO 65109-2444
Phone
(573) 632-5560
Fax
(573) 632-5875
NPI assigned
Aug 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2007017187 MO Primary

Addresses

Primary practice location

1432 Southwest Blvd
Jefferson City, MO 65109-2444

Mailing address

PO Box 1128
1432 Southwest Blvd
Jefferson City, MO 65102-1128
Phone (573) 632-5560

Other identifiers 1

IdentifierTypeStateIssuer
497450601MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090618000024 MO Practitioner - Clinical Social Worker 3173673803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

4625 Lindell Blvd
Suite 200And300
Saint Louis, MO 63108-3725
Phone (866) 630-0966

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
58.17
Promoting interoperability
100
Improvement activities
40
Cost
75.92

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sondermind Provider Network LLC Clinical CurrentSince Apr 28, 2025 Accepting new patients
Fuelling & Associates LLC PastSince Nov 22, 2010 Accepting new patients

Locations

107 W 9th St
Fl 2
Kansas City, MO 64105
Phone (505) 382-2776

4625 Lindell Blvd
Ste 200300
Saint Louis, MO 63108
Phone (314) 396-7900

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363305600000",
    "number": "1518151117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1128",
            "address_2": "1432 SOUTHWEST BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651021128",
            "telephone_number": "573-632-5560",
            "fax_number": "573-632-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 SOUTHWEST BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092444",
            "telephone_number": "573-632-5560",
            "fax_number": "573-632-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETZER",
        "first_name": "STACY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-28",
        "last_updated": "2013-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2007017187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497450601",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.