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Sara Mae Stout

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140

PECOS Enrollment

This provider is enrolled in PECOS as SARA STOUT.

Based on the most recent information from CMS, provider Sara Mae Stout is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1265041016
Provider Type
Individual
Full Name
Stout, Sara Mae
Credential
NP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
7/28/2020
Last Updated
11/2/2023

Contact Information

Practice Location

7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140

(260) 436-2416

(260) 436-6936

Mailing Location

250 N Shadeland Ave, Indianapolis, IN 46219-4959

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 71010502A Indiana
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 28214322A Indiana

Sara Mae Stout

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Schlatter, Andrew J.

Royce, Hope E.

Crook, Sarah E.

Blauvelt, Grant Michael

Nugent, Amy E.

Mauger, Beverly Lynn

Grimshaw, John

Fountain, Pamela Kinder

Heath, Melanie J.

Lombard, Paige Marie