Stacey L Smith, FNP
Individual provider Active NPI Nurse Practitioner · Sullivan, IN
NPI 1912947169 · NPPES record last updated Apr 27, 2021
Key facts
- NPI
- 1912947169
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71000086A (IN)
- Practice address
- 2229 Mary Sherman Dr
Sullivan, IN 47882-7633 - Phone
- (812) 268-3318
- Fax
- (812) 268-4017
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sullivan County Community Hospital
Practice addresses (Care Compare)
2229 Mary Sherman Dr
Sullivan, IN 47882-7633
Phone (812) 268-3318
Hospital & facility affiliations
- Home Health Care Solutions LLC
- Amedisys Home Health
- Sullivan County Community Hospital
- Union Hospital Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140221000739 | IN | Practitioner - Nurse Practitioner | 6103056080 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71000086A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sullivan County Community Hospital | Current |
Accepting new patients | |
| Sullivan County Community Hospital | Current |
Accepting new patients | |
| Sullivan Family Practice, LLC | Current | Accepting new patients |
Locations
2229 Mary Sherman Dr
Sullivan, IN 47882
Phone (812) 238-2100
340 N Section St
Med BLDG B
Sullivan, IN 47882
Phone (812) 268-6333
2186 N Hospital Blvd
Ste 2
Sullivan, IN 47882
Phone (812) 268-3318
2200 N Section St
Sullivan, IN 47882
Phone (812) 268-6292
2200 N Section St
#A
Sullivan, IN 47882
Phone (812) 268-3318
2200 N Section St
Ste A
Sullivan, IN 47882
Phone (812) 268-6292
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71000086A | IN | Yes |
Addresses
Primary practice location
2229 Mary Sherman Dr
Sullivan, IN 47882-7633
Mailing address
2229 Mary Sherman Dr
PO Box 230
Sullivan, IN 47882-7633
Phone (812) 268-3318
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | stacey.smith.3@8793.direct.athenahealth.com | Direct |
Other providers in Sullivan, IN
- Carson Sandy
- Tabitha Dee Simpson
- Darin Sisil
- Gregg W. Smith
- Neil Lynn Smith
- Sydney Danielle Smith
- Solidago Dialysis, LLC
- Southwest School Corporation
- Amy Nicole Sparks
- John Michael Steele
All providers in Sullivan, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.