Individual provider Active NPI

Nathan Stuempfig, D.O.

  • Emergency Medicine Physician
  • Modesto, CA
National Provider Identifier
1003122813
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A13315 Issued in CA
Practice address
4601 Dale Rd
Modesto, CA 95356-9718
Phone
(209) 715-1780
NPI assigned
Aug 31, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125057518 IL
Emergency Medicine Physician 207P00000X 20A13315 CA Primary

Addresses

Primary practice location

4601 Dale Rd
Modesto, CA 95356-9718

Mailing address

5019 N Mozart St
Chicago, IL 60625-3615
Phone (773) 293-3223

Other practice location 1

5140 N California Ave
G400
Chicago, IL 60625-3645
Phone (773) 878-8200

Other identifiers 1

IdentifierTypeStateIssuer
125057518OtherILSTATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140929002805 CA Practitioner - Emergency Medicine 0143440941 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A13315CAMDEmergency Medicine Physician
13315CAMDSpeech-Language Pathologist
125057518ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group, Inc CurrentSince Aug 9, 2014 Accepting new patients
Permanente Medical Group Inc Emergency Medicine Current Accepting new patients
Permanente Medical Group Inc Emergency Medicine CurrentSince Aug 9, 2014 Accepting new patients
Swedish Covenant Management Services, Inc. Past Accepting new patients

Locations

4601 Dale Rd
Modesto, CA 95356
Phone (209) 557-1000

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1003122813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5019 N MOZART ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253615",
            "telephone_number": "773-293-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569718",
            "telephone_number": "209-715-1780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5140 N California Ave",
            "address_2": "G400",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606253645",
            "country_code": "US",
            "telephone_number": "773-878-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STUEMPFIG",
        "first_name": "NATHAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-31",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125057518",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A13315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "125057518",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953569718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.