Stacey Farrell, CNP is a medicare enrolled "Family Medicine" in Destin, Florida. Her current practice location is
4477 Legendary Dr Ste 201, Destin, Florida. You can reach out to her office (for appointments etc.) via phone at
(850) 736-1251.
Stacey Farrell is licensed to practice in Florida (license number 11016785) 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 1154763514.
Provider's Profile
| Full Name | Stacey Farrell |
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| Gender | Female |
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| Speciality | Family Medicine |
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| Location | 4477 Legendary Dr Ste 201, Destin, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1154763514
- Provider Enumeration Date: 07/25/2013
- Last Update Date: 05/10/2025
Medicare PECOS Information:
- PECOS PAC ID: 9335375880
- Enrollment ID: I20131112000644
Medical Identifiers
Medical identifiers for Stacey Farrell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1154763514 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | R855653 (Mississippi) | Secondary |
| 207Q00000X | Family Medicine | 11016785 (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. Stacey Farrell allows following entities to bill medicare on her behalf.
| Entity Name | Delta Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1790701134
PECOS PAC ID: 6608775531
Enrollment ID: O20040108000636 |
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| Entity Name | Bolivar Physician Practices Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1063659530
PECOS PAC ID: 6305995895
Enrollment ID: O20090512000274 |
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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. Stacey Farrell 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 Address | Practice Location Address |
|---|
Stacey Farrell, CNP
411 Fulton St,
Greenwood, MS 38930-4314
Ph: (662) 455-4434 | Stacey Farrell, CNP
4477 Legendary Dr Ste 201,
Destin, FL 32541-5332
Ph: (850) 736-1251 |
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