NPIMap

Individual provider Active NPI

Carly Gene Staab, APRN, FNP-BC

  • Family Nurse Practitioner
  • Bridgeport, CT
National Provider Identifier
1801205463
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5819 Issued in CT
Practice address
982 E Main St
Bridgeport, CT 06608-1913
Phone
(802) 233-1490
NPI assigned
Aug 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5819 CT Primary

Addresses

Primary practice location

982 E Main St
Bridgeport, CT 06608-1913

Mailing address

982 E Main St
Bridgeport, CT 06608-1913

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160106001037 VT Practitioner - Nurse Practitioner 0840411773 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Vermont Medical Center IncGroup PAC ID 3779491071, 1,208 clinicians

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

  • Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003
  • Northwestern Medical Center Inc Hospital, Saint Albans, VT, CCN 470024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5819CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Center, Inc. Current Accepting new patients
Northwestern Medical Center, Inc CurrentSince Apr 9, 2018 Accepting new patients
Northwestern Medical Center, Inc. CurrentSince Jul 1, 2018 Accepting new patients
University of Vermont Medical Center Inc CurrentSince Aug 12, 2023 Accepting new patients
Northwestern Medical Center Inc CurrentSince Apr 9, 2018 Accepting new patients

Locations

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

927 Ethan Allen Hwy
Unit 2
Milton, VT 05468
Phone (802) 524-8911

3 Crest Rd
Saint Albans, VT 05478
Phone (802) 524-4554

260 Crest Rd
Ste 102
Saint Albans, VT 05478
Phone (802) 524-1064

260 Crest Rd
Ste 101
Saint Albans, VT 05478
Phone (802) 524-1223

133 Fairfield St
Ste 101
Saint Albans, VT 05478
Phone (802) 524-1232

133 Fairfield St
Saint Albans, VT 05478
Phone (802) 524-1227

260 Crest Rd
Ste 103
Saint Albans, VT 05478
Phone (802) 524-8911

Interoperability endpoints

  • Direct secure messaging: cstaab144355@direct.uvmhealth.org

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 2

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": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407369600000",
    "number": "1801205463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "802-233-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAAB",
        "first_name": "CARLY",
        "middle_name": "GENE",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "5819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.