Individual provider Active NPI

Staci Robin Hastings, PA

  • Medical Physician Assistant
  • Rome, GA
National Provider Identifier
1639437379
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
715 E 2ND Ave SW
Rome, GA 30161-6148
Phone
(706) 291-9898
NPI assigned
May 1, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 006500 GA
Medical Physician Assistant 363AM0700X GA Primary

Addresses

Primary practice location

715 E 2ND Ave SW
Rome, GA 30161-6148

Mailing address

420 E 2ND Ave Ste 103
Rome, GA 30161-3210
Phone (706) 291-5372

Other identifiers 1

IdentifierTypeStateIssuer
1639437379MedicaidGA

Other names 1

  • Mrs. Staci Robin Graves Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20130304000237 GA Practitioner - Physician Assistant 3678728383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
98.9 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Floyd Healthcare Management Inc CurrentSince May 1, 2014 Accepting new patients
Floyd Healthcare Management Inc CurrentSince May 1, 2014 Accepting new patients
Floyd Healthcare Management Inc Current Accepting new patients

Locations

1025 N Main St
Cedartown, GA 30125
Phone (770) 748-5212

330 Turner McCall Blvd SW
Ste 107
Rome, GA 30165
Phone (706) 509-6439

123 Three Rivers Dr NE
Rome, GA 30161
Phone (706) 295-3961

420 E 2nd Ave
Ste 103
Rome, GA 30161
Phone (706) 509-3278

Organizations & group practices 3

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": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1639437379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 2ND AVE STE 103",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613210",
            "telephone_number": "706-291-5372",
            "fax_number": "706-291-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E 2ND AVE SW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616148",
            "telephone_number": "706-291-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASTINGS",
        "first_name": "STACI",
        "middle_name": "ROBIN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-01",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006500",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639437379",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "GRAVES",
            "middle_name": "ROBIN",
            "prefix": "MRS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.