Individual provider Active NPI

Stacy R Butler

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1710632625
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71012324A Issued in IN
Practice address
11104 Parkview Circle Dr Ste 10
Fort Wayne, IN 46845-1733
Phone
(260) 425-6070
Fax
(260) 425-6073
NPI assigned
Feb 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71012324A IN Primary

Addresses

Primary practice location

11104 Parkview Circle Dr Ste 10
Fort Wayne, IN 46845-1733

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/
Direct Messaging Address sbutler485060@Direct.Parkviewexchange.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20221202000675 IN Practitioner - Nurse Practitioner 3375911969 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

1007 W Rudisill Boulevard
PPG Family Medicine
Fort Wayne, IN 46807-2170
Phone (260) 425-5180

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71012324AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System, Inc. Nurse Practitioner CurrentSince Aug 26, 2022 Accepting new patients
Parkview Health System Inc Nurse Practitioner Current Accepting new patients

Locations

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

11104 Parkview Circle Dr
Ste 10
Fort Wayne, IN 46845
Phone (260) 266-7856

7030 Pointe Inverness Way
Ste 335
Fort Wayne, IN 46804
Phone (260) 969-0801

3828 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 483-9700

1007 W Rudisill Blvd
Fort Wayne, IN 46807
Phone (260) 425-5180

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

Interoperability endpoints

  • Direct secure messaging: sbutler485060@direct.parkviewexchange.com

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": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1710632625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR STE 10",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451733",
            "telephone_number": "260-425-6070",
            "fax_number": "260-425-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "STACY",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-18",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71012324A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "7030 Pointe Inverness Way Ste 335",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468047929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "7030 Pointe Inverness Way Ste 335",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468047929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbutler485060@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "7030 Pointe Inverness Way Ste 335",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468047929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.