Statera LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

STATERA LLC

Practice address

3375 Lake Ridge Drive
Dubuque, IA 52003

Phone

(563) 580-0243

NPI assigned

Jan 24, 2018

Last updated

Jan 24, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Lee Hutchison, PTNPI 1134495708

Title

Owner

Phone

(563) 580-0243

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katherine Therese Gansen, ARNP, FNP-BC

  • Family Nurse Practitioner
  • Manchester, IA
  • NPI 1609024652
  Medicare reassignment Care Compare group NPD
• Lawrence Ronald Hutchison, M.D.

  • Family Medicine Physician
  • Dubuque, IA
  • NPI 1639142805
  Medicare reassignment Care Compare group NPD
• Amy Marie McFadden-Decker, P.T.

  • Physical Therapist
  • Dubuque, IA
  • NPI 1073736518
  Medicare reassignment Care Compare group NPD
• Sarah Ann Mitchell, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Dubuque, IA
  • NPI 1710853239
  Medicare reassignment Care Compare group NPD
• Emily A Roling, ARNP

  • Family Nurse Practitioner
  • Dubuque, IA
  • NPI 1174139315
  Medicare reassignment Care Compare group NPD
• Lynn M Randall, DC

  • Chiropractor
  • Dubuque, IA
  • NPI 1316058506
  Medicare reassignment NPD
• Nicole Hutchison, P.T.

  • Physical Therapist
  • Peosta, IA
  • NPI 1134495708
  NPD Authorized official
• Bailey Louise Callahan, MA

  • Mental Health Counselor
  • Dubuque, IA
  • NPI 1831838887
  NPD
• Macy Elaine McGrane, DNP

  • Family Nurse Practitioner
  • Dubuque, IA
  • NPI 1982481453
  NPD
• Allison Saunders, NBC-HWC

  • Health & Wellness Coach
  • Dubuque, IA
  • NPI 1851101679
  NPD
• Kimberly Tallon

  • Clinical Social Worker
  • Dubuque, IA
  • NPI 1740679745
  NPD
• Karin Anderson, LMHC NCC MS

  • Mental Health Counselor
  • Dubuque, IA
  • NPI 1851796296
  NPD (past)

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1689172751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 LAKE RIDGE DRIVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "52003",
            "telephone_number": "563-580-0243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 LAKE RIDGE DRIVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "52003",
            "telephone_number": "563-580-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATERA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "HUTCHISON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-580-0243",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Michael Stackis, DC
• Matthew J Stader, CRNA
• Marie Rose Stangl
• Shevonne Starry
• State University of Iowa
• Christopher M Steege, DPT
• Amber Jean Steffen, P.T.
• Kenneth Francis Steffen, DO
• Shelby Sue Steffen, COTA/L
• Jessica Steger, ARNP

• Primary Care Clinic/Center in Dubuque, IA
• Providers in Dubuque, IA by specialty
• Primary Care Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.