Individual provider Active NPI

Stacey Harminson, PA-C

  • Physician Assistant
  • Mattoon, IL
National Provider Identifier
1710093018
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-001452 Issued in IL
Practice address
1005 Health Center Dr Ste 104
Mattoon, IL 61938-4693
Phone
(217) 258-2178
Fax
(217) 258-4024
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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 085-001452 IL Primary

Addresses

Primary practice location

1005 Health Center Dr Ste 104
Mattoon, IL 61938-4693

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4693
Phone (217) 238-6055

Other practice location 1

200 Richmond Ave E Ste 1
Mattoon, IL 61938-4652
Phone (217) 234-7000

Other practice location 2

650 Oak Ave
Neoga, IL 62447-1502
Phone (217) 895-2222

Other practice location 3

1100 Tuscola Blvd
Tuscola, IL 61953-2065
Phone (217) 253-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080131000305 IL Practitioner - Physician Assistant 9335221258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1005 Health Ctr Dr
Suite 104
Mattoon, IL 61938-4637
Phone (217) 258-2178

Hospital & facility affiliations

  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-001452ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Nov 4, 2025 Accepting new patients
Sarah Bush Lincoln Health Center Past Accepting new patients

Locations

200 Richmond Ave E
Ste 1
Mattoon, IL 61938
Phone (217) 234-7000

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

1005 Health Center Dr
Ste 104
Mattoon, IL 61938
Phone (217) 258-2178

1100 Tuscola Blvd
Tuscola, IL 61953
Phone (217) 253-2020

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1710093018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384693",
            "telephone_number": "217-238-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 104",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384693",
            "telephone_number": "217-258-2178",
            "fax_number": "217-258-4024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Richmond Ave E Ste 1",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619384652",
            "country_code": "US",
            "telephone_number": "217-234-7000",
            "fax_number": "217-234-7011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "650 Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Neoga",
            "state": "IL",
            "postal_code": "624471502",
            "country_code": "US",
            "telephone_number": "217-895-2222",
            "fax_number": "217-895-3598",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Tuscola Blvd",
            "address_purpose": "LOCATION",
            "city": "Tuscola",
            "state": "IL",
            "postal_code": "619532065",
            "country_code": "US",
            "telephone_number": "217-253-2020",
            "fax_number": "217-253-2023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARMINSON",
        "first_name": "STACEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-001452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.