Stacey Michelin, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

24149 Issued in TN

Practice address

2269 Wilma Rudolph Blvd Ste 106
Clarksville, TN 37040-8416

Phone

(931) 542-9010

Fax

(844) 557-9010

NPI assigned

Jun 1, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stacey Boothe Former name

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Compassion Care ClinicGroup PAC ID 2668706268, 3 clinicians

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vanderbilt Clarksville Hospital Hospital, Clarksville, TN, CCN 440035

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15045/brand/1/csg/1/fhir/r4

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.

• Compassion Care Clinic

  • Family Medicine Physician
  • Clarksville, TN
  • NPI 1164982443
  Medicare reassignment Care Compare group NPD Authorized official

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

• Clarksville Health System, LLC

  dba Tennova Healthcare-Clarksville

  • General Acute Care Hospital
  • Clarksville, TN
  • NPI 1285689794
  Care Compare affiliation

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1750873089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2269 WILMA RUDOLPH BLVD STE 106",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408416",
            "telephone_number": "931-542-9010",
            "fax_number": "844-557-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2269 WILMA RUDOLPH BLVD STE 106",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408416",
            "telephone_number": "931-542-9010",
            "fax_number": "844-557-9010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 8th St",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "37040",
            "country_code": "US",
            "telephone_number": "931-542-9010",
            "fax_number": "931-542-9019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHELIN",
        "first_name": "STACEY",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "24149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "83-1860610",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "BOOTHE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heath Ryan Meyer, DDS
• Mary Meyer, FNP
• Zachary Meyer, D.D.S
• MH Health Care Services, PC
• Jocelyn Michael, BSW
• Justin M. Mickles, MS
• Mid Cumberland Infectious Disease Consultants PLC
• Middle Tennessee Imaging, LLC (Premier Radiology Clarksville)
• Middle Tennessee Imaging, LLC (Premier Radiology)
• Middle TN Home Health LLC. (ComForCare Home Care Clarksville)

• Family Nurse Practitioner in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.