NPIMap

Individual provider Active NPI

Stacey Maria Walton, PA-C

  • Physician Assistant
  • Lisbon, ND
National Provider Identifier
1801868062
Registry record updated Apr 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0336 Issued in ND
Practice address
10 9TH Ave E
Lisbon, ND 58054-4738
Phone
(701) 683-4711
Fax
(701) 683-3205
NPI assigned
Feb 2, 2006
Last updated
Apr 29, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0336 ND Primary

Addresses

Primary practice location

10 9TH Ave E
Lisbon, ND 58054-4738

Mailing address

10 9TH Ave E
Lisbon, ND 58054-4738
Phone (701) 683-4711

Other identifiers 1

IdentifierTypeStateIssuer
26331OtherNDBCBS ND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20051105000371 ND Practitioner - Physician Assistant 6406874668 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

21 Wiley Ave S
Lidgerwood, ND 58053-4001
Phone (701) 538-4189

420 S 7TH St
Oakes, ND 58474-2024
Phone (701) 742-3267

69 Hwy 13 W
Gwinner, ND 58040-4127
Phone (701) 678-2263

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC0336NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lisbon Area Health Services CurrentSince Aug 28, 2018 Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 25, 2022 Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 25, 2022 Accepting new patients
Lisbon Area Health Services Past Accepting new patients
CHI Health Connect at Home-Fargo Past Accepting new patients
Family Medical Clinic PC PastSince Sep 1, 2000 Accepting new patients

Locations

3276 Solutions Ctr
Chicago, IL 60677

2603 E Broadway Ave
Bismarck, ND 58501
Phone (701) 232-5222

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1801868062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 9TH AVE E",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544738",
            "telephone_number": "701-683-4711",
            "fax_number": "701-683-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 9TH AVE E",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544738",
            "telephone_number": "701-683-4711",
            "fax_number": "701-683-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTON",
        "first_name": "STACEY",
        "middle_name": "MARIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ND",
            "identifier": "26331",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisbon, ND

Sources for this page

Verify at the official NPI Registry.