NPIMap

Individual provider Active NPI

Stacey A Smith, MD

  • Family Medicine Physician
  • Detroit Lakes, MN
National Provider Identifier
1649210832
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44095 Issued in MN
Practice address
1245 Washington Ave
Detroit Lakes, MN 56501-3923
Phone
(218) 846-2000
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44095 MN Primary

Addresses

Primary practice location

1245 Washington Ave
Detroit Lakes, MN 56501-3923

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Other identifiers 11

IdentifierTypeStateIssuer
0107063OtherMNMEDICA #
20696OtherMNNDBS #
677682500MedicaidMN
1280970OtherMNAMERICA'S PPO/ARAZ #
43G89SMOtherMNMNBS #
0107064OtherMNMEDICA #
142065OtherMNUCARE #
DA9031028234OtherMNPREFERRED ONE #
11146MedicaidMN
HP38211OtherMNHEALTHPARTNERS #
MN100045OtherMNLHS/BANNERHEALTH #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080118000308 MN Practitioner - Family Practice 8729169446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone (218) 846-2000

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

211 E Mill St
Pelican Rapids, MN 56572-4234
Phone (218) 863-6100

Hospital & facility affiliations

  • Vivie Home Health Home health agency, Alexandria, MN, CCN 248096
  • Sanford Home Care Fargo Home health agency, Fargo, ND, CCN 357037
  • Vivie Hospice Hospice, Alexandria, MN, CCN 241592
  • Hia Hospice Hospice, Fargo, ND, CCN 351500
  • Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
  • Perham Health Hospital, Perham, MN, CCN 241373
  • Prairie Ridge Hospital and Health Services Hospital, Elbow Lake, MN, CCN 241379
  • Pelican Valley Health Center Nursing home, Pelican Rapids, MN, CCN 245373

Merit-based Incentive Payment System (MIPS)

Final score
88.99 of 100Reported as group
Quality
92.39
Promoting interoperability
100
Improvement activities
40
Cost
70.9

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Family Medicine CurrentSince Jan 23, 2012 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jan 23, 2012 Accepting new patients
Pelican Valley Health Center Past Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

1245 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 846-2000

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

211 E Mill St
Pelican Rapids, MN 56572
Phone (218) 863-6100

Organizations & group practices 4

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1649210832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013923",
            "telephone_number": "218-846-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACEY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0107063",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS #",
            "identifier": "20696",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "677682500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO/ARAZ #",
            "identifier": "1280970",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "43G89SM",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0107064",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE #",
            "identifier": "142065",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE #",
            "identifier": "DA9031028234",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11146",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS #",
            "identifier": "HP38211",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LHS/BANNERHEALTH #",
            "identifier": "MN100045",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.