NPIMap

Individual provider Active NPI

Stacy Wayne Slade, PA-C

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1669996567
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1852 Issued in NV
Practice address
4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone
(702) 669-5840
NPI assigned
Aug 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1852 NV Primary

Addresses

Primary practice location

4475 S Eastern Ave
Las Vegas, NV 89119-7826

Mailing address

7150 W Sunset Rd
Ste 201a
Las Vegas, NV 89113-1981
Phone (702) 316-1622

Other identifiers 2

IdentifierTypeStateIssuer
V52094OtherNVSMA MEDICARE
1669996567MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20170816001902 NV Practitioner - Physician Assistant 7911279682 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Las Vegas Urology LLPGroup PAC ID 5294713335, 51 clinicians

Practice addresses (Care Compare)

7150 W Sunset Rd
Las Vegas, NV 89113-1982

7500 Smoke Ranch Rd
Suite 200
Las Vegas, NV 89128-0373
Phone (702) 233-0727

7501 Trinity Peak Ave
Las Vegas, NV 89128-9026
Phone (702) 803-8874

Hospital & facility affiliations

  • University Medical Center Hospital, Las Vegas, NV, CCN 290007
  • Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290021
  • Spring Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290046
  • Mountainview Hospital Hospital, Las Vegas, NV, CCN 290039
  • Southern Hills Hospital and Medical Center Hospital, Las Vegas, NV, CCN 290047

Merit-based Incentive Payment System (MIPS)

Final score
88.26 of 100Reported as group
Quality
90.39
Improvement activities
40
Cost
78.5

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: stacyslade@lvu.medalliesdirect.net

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.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1669996567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 W SUNSET RD",
            "address_2": "STE 201A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891131981",
            "telephone_number": "702-316-1622",
            "fax_number": "702-951-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197826",
            "telephone_number": "702-669-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLADE",
        "first_name": "STACY",
        "middle_name": "WAYNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-01",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICARE",
            "identifier": "V52094",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669996567",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.