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STACY SHAUNA HETHMAN NP
NPI 1336039379
Nurse Practitioner in East Hartford, CT

Active since July 09, 2025PECOS Enrolled
21 WOOD DR, EAST HARTFORD, CT 06108(860) 478-5249 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Stacy Shauna Hethman Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY SHAUNA HETHMAN NP (NPI 1336039379) is an individual nurse practitioner in East Hartford, Connecticut, licensed in Connecticut (14839) and active in the NPI registry since July 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1336039379
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameSTACY SHAUNA HETHMANCredential: NP
Location Address21 WOOD DREast Hartford, CT 06108-1232
Mailing Address21 Wood DrEast Hartford, CT 06108-1232 · (860) 478-5249
Phone(860) 478-5249
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateJuly 9, 2025
NPPES CertifiedJuly 9, 2025
✔ NPI 1336039379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CT · 14839
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
21 WOOD DR, East Hartford, CT 06108
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stacy Shauna Hethman Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2769986793
PECOS Enrollment IDI20250922001322
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Stacy Hethman reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Matrix Medical Plus
854 mi
Nurse Practitioner
424 CHURCH ST STE 2600
Nashville, TN 37219
  • Reassigned Medicare billing, Connecticut enrollment
  • 79 clinicians in this Medicare group
NPI 1376973461 (877) 564-3627

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 06108 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$93.86 typical visit price
range $60.82 – $183.10
Typical copayment $23.46 (range $15.20 – $45.77)
Most-billed visit code 99203
Established Patient
$106.68 typical visit price
range $19.76 – $149.26
Typical copayment $26.67 (range $4.94 – $37.31)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacy Hethman's NPI number?

The NPI number for Stacy Hethman is 1336039379. It was assigned to this individual provider in the NPPES registry on July 9, 2025.

Where is Stacy Hethman located?

Stacy Hethman practices at 21 Wood Dr, East Hartford, CT 06108. The listed phone number is (860) 478-5249.

What is Stacy Hethman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Stacy Hethman enrolled in Medicare?

Yes. Stacy Hethman is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stacy Hethman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stacy Hethman reassigns Medicare benefits to Matrix Medical Plus (Nashville, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stacy Hethman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stacy Hethman was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.