STACY L NELSON (PA-C) – Physician Assistant, NPI 1124280771
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for STACY L NELSON (PA-C)
1650 4TH ST SE
ROCHESTER, MN 559044717
Phone: (507) 529-6600
Type: Mailing
361 SOMERSET DR
RAEFORD, NC 283765437
Phone: (218) 340-4779
Type: Mailing
Southeastern Health, 300, West 27th Street, Lumberton, Robeson County, North Carolina, 28359, United States
LUMBERTON, NC 283591408
Phone: (910) 671-5345
Type: Location
2925 CHICAGO AVE
MINNEAPOLIS, MN 554071321
Phone: (612) 262-9000
Type: Mailing
8170 OLD CARRIAGE CT STE 100
SHAKOPEE, MN 553793164
Phone: (952) 428-3600
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-06-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160613000649 | I | Physician Assistant | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 51 | 50 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 50 | 49 | $0 |
Insurance plans in this area (ZIP 55904)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| - | MN | |
| - | ND | |
| - | MN | |
| - | WI | |
| Physician Assistant | MN | |
| - | MN | |
| - | MN | |
| - | MN | |
| - | NE |
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