NPIMap

Individual provider Active NPI

Staci Faye Bishop, PAC

  • Physician Assistant
  • Springfield, CO
National Provider Identifier
1922176643
Registry record updated Apr 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA849 Issued in CO
Practice address
373 East 10TH Avenue
Springfield, CO 81073-0000
Phone
(719) 523-6628
Fax
(719) 523-4513
NPI assigned
Dec 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2013

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 PA849 CO Primary

Addresses

Primary practice location

373 East 10TH Avenue
Springfield, CO 81073-0000

Mailing address

373 East 10TH Avenue
Springfield, CO 81073-0000
Phone (719) 523-6628

Other identifiers 1

IdentifierTypeStateIssuer
07008493MedicaidCO

Other names 1

  • Ms. Staci Faye Jacobs Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20090421000564 CO Practitioner - Physician Assistant 9830246230 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Colorado School of Medicine, Denver, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Colorado Hospital DistrictGroup PAC ID 6204725138, 13 clinicians

Practice addresses (Care Compare)

900 Church St
Springfield, CO 81073-1636
Phone (719) 523-2125

Hospital & facility affiliations

  • Southeast Colorado Hospital Home Health Agency Home health agency, Springfield, CO, CCN 067198
  • Southeast Colorado Hospital District Hospital, Springfield, CO, CCN 061311
  • Prowers Medical Center Hospital, Lamar, CO, CCN 061323

Merit-based Incentive Payment System (MIPS)

Final score
36.1 of 100Reported as group
Quality
57.82
Improvement activities
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
849COMDOccupational Therapy Assistant
PA849COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Colorado Hospital District PastSince Apr 25, 2021 Accepting new patients
Southeast Colorado Hospital District Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14274/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/68fd0d26-06fa-4584-8f6d-b42cfd864525/

Organizations & group practices 3

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 6

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366761600000",
    "number": "1922176643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 EAST 10TH AVENUE",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810730000",
            "telephone_number": "719-523-6628",
            "fax_number": "719-523-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 EAST 10TH AVENUE",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810730000",
            "telephone_number": "719-523-6628",
            "fax_number": "719-523-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "STACI",
        "middle_name": "FAYE",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2013-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07008493",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "JACOBS",
            "middle_name": "FAYE",
            "prefix": "MS.",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, CO

Sources for this page

Verify at the official NPI Registry.