Stacey Lyn Ice, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP.019449 Issued in OH

Practice address

4235 Secor Rd
Toledo, OH 43623-4231

Phone

(419) 479-5418

NPI assigned

Jul 15, 2016

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 names 1

• Stacey Lyn Latkovic Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Medical College of Ohio, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Defiance Hospital Inc.Group PAC ID 6305754557, 4 clinicians

Toledo Pain Services, PLLGroup PAC ID 8921912189, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
• Promedica Defiance Regional Hospital Hospital, Defiance, OH, CCN 361328
• Mercy St Vincent Medical Center Hospital, Toledo, OH, CCN 360112

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Defiance Hospital, Inc.

  • Physical Therapy Clinic/Center
  • Defiance, OH
  • NPI 1629216684
  Medicare reassignment Care Compare group NPD
• Toledo Pain Services, PLL

  • Interventional Pain Medicine Physician
  • Toledo, OH
  • NPI 1356339857
  Medicare reassignment Care Compare group NPD
• Defiance Hospital Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Defiance, OH
  • NPI 1881092443
  NPD
• Defiance Hospital Inc.

  • Critical Access Hospital
  • Defiance, OH
  • NPI 1699775726
  NPD
• Toledo Pain Services, PLL

  • Certified Registered Nurse Anesthetist
  • Oregon, OH
  • NPI 1427703024
  NPD
• Defiance Regional Medical Center

  • Rural Acute Care Hospital
  • Defiance, OH
  • NPI 1528068665
  NPD (past)

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

• Defiance Hospital Inc.

  • Critical Access Hospital
  • Defiance, OH
  • NPI 1699775726
  Care Compare affiliation
• Mercy Health - St Vincent Medical Center LLC

  • General Acute Care Hospital
  • Toledo, OH
  • NPI 1467493551
  Care Compare affiliation
• The Toledo Hospital

  • General Acute Care Hospital
  • Toledo, OH
  • NPI 1407854771
  Care Compare affiliation
• Toledo Hospital

  • Ambulance
  • Toledo, OH
  • NPI 1427147339

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1861845786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 SECOR RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436234231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 SECOR RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436234231",
            "telephone_number": "419-479-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICE",
        "first_name": "STACEY",
        "middle_name": "LYN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "CNP.019449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "LATKOVIC",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gianluca Emanuele Ianiro
• Nadira Omar Ibrahim, CNP
• Rahaf Ibrahim
• Safa Ibrahim, MPH, CTTS
• Farah Ibraik
• Samantha Ide, MSW, LSW
• Ideal Lifestyle LLC
• Mahogany R Idichandy, MD
• Mathew T Idichandy, MD
• Saffa Iftikhar, MD

• Family Nurse Practitioner in Toledo, OH
• Providers in Toledo, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.