Stacey Lee Konzak, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0348 Issued in ND

Practice address

2900 E Broadway Ave
Bismarck, ND 58501-5112

Phone

(701) 221-9997

NPI assigned

Dec 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Stacey Lee Berg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mercy Hospital

  • Durable Medical Equipment & Medical Supplies
  • Valley City, ND
  • NPI 1457313819
  NPD
• Mercy Hospital of Devils Lake

  • Clinic/Center
  • Devils Lake, ND
  • NPI 1184117293
  NPD
• Carrington Health Center

  • Rural Health Clinic/Center
  • New Rockford, ND
  • NPI 1801811666
  NPD (past)
• Center for Solutions, P.C.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Devils Lake, ND
  • NPI 1780840223
  NPD (past)
• Transitional Living Center Inc

  • Substance Abuse Rehabilitation Facility
  • Devils Lake, ND
  • NPI 1255656765
  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1962486969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5713 80TH AVE NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583019657",
            "telephone_number": "701-303-0263",
            "fax_number": "701-395-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E BROADWAY AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585015112",
            "telephone_number": "701-221-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONZAK",
        "first_name": "STACEY",
        "middle_name": "LEE",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0537",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6825030",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71237",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "BERG",
            "middle_name": "LEE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth B Kollie
• Sanya L Kom, LPN
• Godwin Nakpan Konde
• Sai Nikhil Konduru, MD
• Sa Kong
• Gerard F Koorbusch, DDS, MBA
• Matthew John Kopp, FNP-C
• Donald J Kosiak, MD
• Julie Kost
• Katelynn Marie Kostelecky-Belland, DPT

• All providers in Bismarck, ND
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.