Active NPI
Rebecca Sue Stutz, PA-C
- Physician Assistant
- Detroit Lakes, MN
National Provider Identifier
1780837641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 12383
- Practice address
- 1027 Washington Ave
Detroit Lakes, MN 56501 - Phone
- (218) 847-5611
- NPI assigned
- Oct 23, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 750 | ND | |
| Physician Assistant | 363A00000X | 12383 | MN | Primary |
Addresses
Primary practice location
1027 Washington Ave
Detroit Lakes, MN 56501
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-4222
Other practice location 1
2101 Elm St. N (120)
Fargo, ND 58102-2417
Phone (800) 410-9723 ext. 93745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 750 | ND | MD | Physical Therapy Assistant |
| 12383 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| After Hours Medical LLC | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Jamestown, ND
- NPI 1710496310
-
- Urgent Care Clinic/Center
- Draper, UT
- NPI 1437251279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1780837641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581034940",
"telephone_number": "701-364-4222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1027 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "56501",
"telephone_number": "218-847-5611"
}
],
"practiceLocations": [
{
"address_1": "2101 Elm St. N (120)",
"address_purpose": "LOCATION",
"city": "Fargo",
"state": "ND",
"postal_code": "581022417",
"country_code": "US",
"telephone_number": "800-410-9723 x93745",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STUTZ",
"first_name": "REBECCA",
"middle_name": "SUE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-23",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ND",
"license": "750",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "12383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.