NPIMap

Individual provider Active NPI

Stacy A. Forrestt, PAC

  • Physician Assistant
  • Shawnee Mission, KS
National Provider Identifier
1881702298
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1501310 Issued in KS
Practice address
9100 W. 74TH Street
Shawnee Mission, KS 66204-4004
Phone
(913) 676-2679
Fax
(913) 789-3191
NPI assigned
Aug 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA003020L PA
Physician Assistant 363A00000X 1501310 KS Primary

Addresses

Primary practice location

9100 W. 74TH Street
Shawnee Mission, KS 66204-4004

Mailing address

PO Box 411895
Kansas City, MO 64141-1895
Phone (913) 632-2230

Other identifiers 3

IdentifierTypeStateIssuer
42508017OtherKSBCBS KC
200623680AMedicaidKS
P00765509OtherKSRR MEDICARE

Other names 1

  • Stacy Statler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20091008000015 KS Practitioner - Physician Assistant 7618921453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Anesthesia Associates, PAGroup PAC ID 4981597838, 89 clinicians

Practice addresses (Care Compare)

7315 E Frontage Rd
Suite 140
Merriam, KS 66204-1600
Phone (913) 676-2370

9100 W 14TH St
Shawnee Mission, KS 66204-4004
Phone (913) 632-2230

Hospital & facility affiliations

  • Adventhealth Shawnee Mission Hospital, Shawnee Mission, KS, CCN 170104
  • University of Kansas Hospital Hospital, Kansas City, KS, CCN 170040
  • Adventhealth South Overland Park, Inc Hospital, Overland Park, KS, CCN 170208
  • Kansas City Orthopaedic Institute Hospital, Leawood, KS, CCN 170188
  • Providence Medical Center Hospital, Kansas City, KS, CCN 170146

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1501310KSMDPhysician Assistant

Organizations & group practices 1

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 7

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": "1156550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1881702298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411895",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641411895",
            "telephone_number": "913-632-2230",
            "fax_number": "913-632-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 W. 74TH STREET",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662044004",
            "telephone_number": "913-676-2679",
            "fax_number": "913-789-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORRESTT",
        "first_name": "STACY",
        "middle_name": "A.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-26",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA003020L",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1501310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC",
            "identifier": "42508017",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200623680A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00765509",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "STATLER",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shawnee Mission, KS

Sources for this page

Verify at the official NPI Registry.