Individual provider Active NPI

Christine C Stallkamp, M.D.

  • Family Medicine Physician
  • Broomall, PA
National Provider Identifier
1023008596
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD425231 Issued in PA
Practice address
1991 Sproul Road
Suite 625
Broomall, PA 19008-3518
Phone
(484) 421-1669
Fax
(484) 565-8556
NPI assigned
Oct 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD425231 PA Primary

Addresses

Primary practice location

1991 Sproul Road
Suite 625
Broomall, PA 19008-3518

Mailing address

1991 Sproul Road
Suite 625
Broomall, PA 19008-3518
Phone (484) 421-1669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20041209000309 PA Practitioner - Family Practice 6507822608 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Associates PC Past Accepting new patients

Organizations & group practices 2

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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1023008596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1991 SPROUL ROAD",
            "address_2": "SUITE 625",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083518",
            "telephone_number": "484-421-1669",
            "fax_number": "484-565-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 SPROUL ROAD",
            "address_2": "SUITE 625",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083518",
            "telephone_number": "484-421-1669",
            "fax_number": "484-565-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLKAMP",
        "first_name": "CHRISTINE",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-26",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD425231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomall, PA

Sources for this page

Verify at the official NPI Registry.