Stacey Gidner Wudyka, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704202910 Issued in MI

Practice address

11368 Allen Rd
Taylor, MI 48180-4372

Phone

(734) 403-2222

Fax

(734) 403-2400

NPI assigned

Jan 31, 2018

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 MI, FL, PA, TX4 enrollments

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 4

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Monogram Health Professional Services of Florida LLCGroup PAC ID 0244608149, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacey.wudyka.1@22854.direct.athenahealth.com
• Direct secure messaging: swudyka@landmarkhealth-direct.org

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.

• Monogram Health Professional Services of Florida LLC

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1538883111

  Family

  Medicare reassignment Care Compare group NPD
• Monogram Health Professional Services PC

  • Nephrology Physician
  • Brentwood, TN
  • NPI 1134739089

  Family, MI, PA

  Medicare reassignment NPD
• Monogram Health Professional Services of Texas PLLC

  • Nephrology Physician
  • Brentwood, TN
  • NPI 1396481255

  TX

  Medicare reassignment
• Monogram Health Professional Services PC

  • Nephrology Physician
  • Brentwood, TN
  • NPI 1952917122

  Family

  NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  NPD (past)

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1649778069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11368 ALLEN RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804372",
            "telephone_number": "734-403-2222",
            "fax_number": "734-403-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11368 ALLEN RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804372",
            "telephone_number": "734-403-2222",
            "fax_number": "734-403-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUDYKA",
        "first_name": "STACEY",
        "middle_name": "GIDNER",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-31",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704202910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roshelle Woods, BA
• Woodward Detroit CVS LLC
• Sarah Woodward, LCSW
• Jennifer R Wooley, NP
• David Raymond Wright, M.A., L.P.C.
• Xro Drive
• Robert A Yagoobian, DPM
• Durga V. Yalamanchili, M.D.
• Maria K Yaldo, M.D.
• Madocht Yelda

• Family Nurse Practitioner in Taylor, MI
• Providers in Taylor, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; 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.