Individual provider Active NPI

Stacy Matthew Hockett, M.D.

  • Family Medicine Physician
  • Brooklyn Park, MN
National Provider Identifier
1831152842
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39791 Issued in MN
Practice address
10000 Zane Ave N
Brooklyn Park, MN 55443-1400
Phone
(763) 572-5710
Fax
(763) 569-6200
NPI assigned
Apr 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39791 MN Primary

Addresses

Primary practice location

10000 Zane Ave N
Brooklyn Park, MN 55443-1400

Mailing address

6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710

Other identifiers 9

IdentifierTypeStateIssuer
751453100MedicaidMN
HP39201OtherMNHEALTHPARTNERS
1034895OtherMNPREFERRED ONE
68F04HOOtherMNBCBS OF MN
1892373OtherMNAMERICA'S PPO
6606626OtherMNMEDICA UC
7416497OtherMNAETNA
0114149OtherMNMEDICA
121194OtherMNUCARE MN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051221000680 MN Practitioner - Family Practice 5991727653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

10000 Zane Ave N
Brooklyn Park, MN 55443-1400
Phone (763) 528-6999

13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (612) 626-5775

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

14500 99TH Ave N
Suite 100
Maple Grove, MN 55369-4738
Phone (763) 898-1000

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

6320 Wedgwood Rd N
Maple Grove, MN 55311-3647
Phone (763) 268-0400

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

  • Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39791MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2008 Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2010 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Health Services CurrentSince Jan 1, 2008 Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2010 Accepting new patients
Fairview Clinics Past Accepting new patients
Columbia Park Medical Group, PA Family Medicine Past Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

6401 University Ave NE
Minneapolis, MN 55432
Phone (763) 572-5706

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

400 Stinson Blvd
#2
Minneapolis, MN 55413
Phone (612) 672-2294

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

6320 Wedgwood Rd N
Osseo, MN 55311
Phone (763) 268-0400

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

4000 Central Ave NE
Saint Anthony, MN 55421
Phone (763) 572-5700

Interoperability endpoints

  • Direct secure messaging: shockett5501@fairview.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1831152842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324341",
            "telephone_number": "763-572-5710",
            "fax_number": "763-571-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 ZANE AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431400",
            "telephone_number": "763-572-5710",
            "fax_number": "763-569-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOCKETT",
        "first_name": "STACY",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "39791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "751453100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP39201",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1034895",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "68F04HO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "1892373",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA UC",
            "identifier": "6606626",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7416497",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0114149",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "121194",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

Verify at the official NPI Registry.