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SHANTORIUS SHANTAE STACKS FNP
NPI 1790489961
Nurse Practitioner - Family in Atlanta, GA

Active since March 29, 2023PECOS EnrolledAccepts Medicare Assignment
2219 BENIDORM CT, ATLANTA, GA 30349(770) 572-7109 Get Directions Write a Review

NPPES record last updated: October 29, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Shantorius Shantae Stacks Fnp NPPES

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

SHANTORIUS SHANTAE STACKS FNP (NPI 1790489961) is an individual family provider in Atlanta, Georgia, licensed in Georgia (APRN-NP256370) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1790489961
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameSHANTORIUS SHANTAE STACKSCredential: FNP
Location Address2219 BENIDORM CTAtlanta, GA 30349-8497
Mailing Address2219 Benidorm CtAtlanta, GA 30349-8497 · (770) 572-7109
Phone(770) 572-7109
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateMarch 29, 2023
Last NPPES UpdateOctober 29, 2025
NPPES CertifiedOctober 29, 2025
✔ NPI 1790489961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in GA · APRN-NP256370
2219 BENIDORM CT, Atlanta, GA 30349
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shantorius Shantae Stacks Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113451147
PECOS Enrollment IDI20241113000776
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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Detection test by immunoassay with direct visual observation for influenza virus 87804
This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.
24 services12 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
15 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30349 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
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
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 Shantorius Stacks's NPI number?

The NPI number for Shantorius Stacks is 1790489961. It was assigned to this individual provider in the NPPES registry on March 29, 2023.

Where is Shantorius Stacks located?

Shantorius Stacks practices at 2219 Benidorm Ct, Atlanta, GA 30349. The listed phone number is (770) 572-7109.

What is Shantorius Stacks's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Shantorius Stacks enrolled in Medicare?

Yes. Shantorius Stacks is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Shantorius Stacks was last updated on October 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.