Stacy Wideman, - Medicare Nurse Practitioner in Doral, FL

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Stacy Wideman, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Doral, Florida. Her current practice location is 8450 Nw 102nd Ave, Doral, Florida. You can reach out to her office (for appointments etc.) via phone at (360) 643-6562.

Stacy Wideman is licensed to practice in Florida (license number APRN11012260) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1386243871.

Contact Information

Stacy Wideman,
8450 Nw 102nd Ave,
Doral, FL 33178-4750
(360) 643-6562
Not Available

Map and Direction




Provider's Profile

Full NameStacy Wideman
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location8450 Nw 102nd Ave, Doral, Florida
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1386243871
  • Provider Enumeration Date: 10/26/2020
  • Last Update Date: 03/01/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 7416363478
  • Enrollment ID: I20210317001383

Medical Identifiers

Medical identifiers for Stacy Wideman such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1386243871NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP0808XNurse Practitioner - Psychiatric/mental Health C-RXN.0001379 (Colorado)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health APRN61166084-NP (Washington)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health RN225736 (Georgia)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 202104630NP-PP (Oregon)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 9501782 (California)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 1071418 (Texas)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health G168450 (Iowa)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health APRN11012260 (Florida)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stacy Wideman allows following entities to bill medicare on her behalf.
Entity NamePersonal Recovery Network Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1881990869
PECOS PAC ID: 5092611384
Enrollment ID: O20120110000096
Entity NameInvigoration Health Corp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033856307
PECOS PAC ID: 8729462106
Enrollment ID: O20220902001401

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stacy Wideman is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Stacy Wideman,
3235 Satellite Blvd Ste 300,
Duluth, GA 30096-8688

Ph: (360) 643-6562		Stacy Wideman,
8450 Nw 102nd Ave,
Doral, FL 33178-4750

Ph: (360) 643-6562

Reviews and Comments


Nurse Practitioner Nurses in Doral, FL

Carlos Hernandez Vazquez,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 9250 Nw 36th St Ste 420, Doral, FL 33178
Phone: 305-266-2929    
Axis Morales Fernandez, IMG, MSN, FNP - BC
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 9250 Nw 25th St, Doral, FL 33172
Phone: 786-597-4951    
Ivania G Castillo, APRN
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 8175 Nw 12th St Ste 306, Doral, FL 33126
Phone: 305-575-3800    Fax: 305-470-5846
Jovina Morales, ARNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 8175 Nw 12th St Ste 306, Doral, FL 33126
Phone: 786-845-0164    Fax: 305-470-5846
Joel Luis Polanco, NP-C
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 2000 Nw 87th Ave Ste 101, Doral, FL 33172
Phone: 844-665-4827    
Alina Padron Rodriguez, MSN
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 9250 Nw 36th St Ste 420, Doral, FL 33178
Phone: 305-266-2929    Fax: 305-406-9478
Dr. Arisleidy Morejon Romero, AGACNP
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 2801 Nw 79th Ave, Doral, FL 33122
Phone: 305-239-6027    Fax: 305-239-6037

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.