CMS-1500 Box 24J / 33a • NPI
1407695182
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LG0600X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology
Box 32 Service Location & ZIP+4
19270 SONOMA HIGHWAY, SONOMA, CA, 95476
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1407695182 (STACIE ANDERSON, AGNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1407695182 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | STACIE ANDERSON, AGNP |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology NUCC Code: 363LG0600X (Nurse Practitioner, Gerontology) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 19270 SONOMA HIGHWAY, SONOMA, CA, 95476 |
| Practice Telephone / Fax | Tel: (707) 939-6070 |
| Administrative Mailing Address | 911 LAKEVILLE ST # 116, PETALUMA, CA, 94952-3329 |
| Enumeration & Last Sync | Enumerated: 2024-05-22 | CMS Record Updated: 2024-05-22 |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (363LG0600X)
What Does Taxonomy Code 363LG0600X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LG0600X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (STACIE ANDERSON, AGNP)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: CA | License: 95029378 | Primary: Secondary |
363LP2300X — Nurse Practitioner, Primary CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care | State: CA | License: 95029378 | Primary: Secondary |
363LG0600X — Nurse Practitioner, GerontologyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology | State: CA | License: 95029378 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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