NPIMap

Individual provider Active NPI

Stacy J Zimney, PA-C

  • Physician Assistant
  • Pelican Rapids, MN
National Provider Identifier
1952322299
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9966 Issued in MN
Practice address
211 E Mill St
Pelican Rapids, MN 56572
Phone
(218) 863-6100
Fax
(218) 863-6173
NPI assigned
Jul 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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 9966 MN
Physician Assistant 363A00000X 9966 MN Primary

Addresses

Primary practice location

211 E Mill St
Pelican Rapids, MN 56572

Mailing address

211 E Mill St, PO Box 737
Pelican Rapids, MN 56572
Phone (218) 863-6100

Other identifiers 2

IdentifierTypeStateIssuer
483903000MedicaidMN
71194MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050302000359 MN Practitioner - Physician Assistant 6709839772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone (218) 846-2000

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9966MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jul 1, 2011 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 1, 2011 Accepting new patients
Sanford Clinic North Past Accepting new patients

Locations

1245 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 846-2000

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

211 E Mill St
Pelican Rapids, MN 56572
Phone (218) 863-6100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1952322299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E MILL ST, PO BOX 737",
            "city": "PELICAN RAPIDS",
            "state": "MN",
            "postal_code": "56572",
            "telephone_number": "218-863-6100",
            "fax_number": "218-863-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E MILL ST",
            "city": "PELICAN RAPIDS",
            "state": "MN",
            "postal_code": "56572",
            "telephone_number": "218-863-6100",
            "fax_number": "218-863-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMNEY",
        "first_name": "STACY",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-22",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "9966",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "483903000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71194",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pelican Rapids, MN

Sources for this page

Verify at the official NPI Registry.