Mary Jaeger Stacy, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

101-0019775 Issued in VT

Practice address

5957 Main St
Northshire Medical Center
Manchester Center, VT 05255-8913

Phone

(802) 362-4440

Fax

(802) 362-7146

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Southwestern Vermont Medical Center, Inc

  • Orthopaedic Surgery Physician
  • Bennington, VT
  • NPI 1487930632
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389571200000",
    "number": "1790741072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5957 MAIN STREET",
            "address_2": "NORTHSHIRE MEDICAL CENTER",
            "city": "MANCHESTER",
            "state": "VT",
            "postal_code": "05255",
            "telephone_number": "802-362-4440",
            "fax_number": "802-362-7146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5957 MAIN ST",
            "address_2": "NORTHSHIRE MEDICAL CENTER",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052558913",
            "telephone_number": "802-362-4440",
            "fax_number": "802-362-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "MARY",
        "middle_name": "JAEGER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2014-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VT",
            "license": "101-0019775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0NP1782",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Susan Smith
• Southern Vermont Audiology, Inc.
• Southwestern Vermont Medical Center Inc
• Karol Sowulewski
• Mary Corinne Squire, DDS
• April B. Stein, PH.D.
• Step Ahead ABA VT LLC
• Thomas A Sterling, DO
• Benjamin Stillman, PSY.D.
• Taconic Orthopaedics PC

• Family Nurse Practitioner in Manchester Center, VT
• Providers in Manchester Center, VT by specialty
• Family Nurse Practitioner in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.