NPIMap

Individual provider Active NPI

Jeffery David Stahl, D.O

  • Interventional Cardiology Physician
  • Buffalo, NY
National Provider Identifier
1023399870
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
299656 Issued in NY
Practice address
100 High St
Buffalo, NY 14203-1126
Phone
(716) 859-7937
NPI assigned
Sep 7, 2011
Last updated
Feb 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS016611 PA
Internal Medicine Physician 207R00000X 299656 NY
Interventional Cardiology Physician 207RI0011X 299656 NY Primary

Addresses

Primary practice location

100 High St
Buffalo, NY 14203-1126

Mailing address

307 S Front St
Harrisburg, PA 17104-1621

Other practice location 1

4300 Londonderry Rd
Harrisburg, PA 17109-5317
Phone (717) 231-8772

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210304002695 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Osteopathic Manipulative Medicine 7911139688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Lake Erie College of Osteopathic Medicine, Erie, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

100 High St
Buffalo, NY 14203-1126
Phone (716) 859-1400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting52
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
299656NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Apr 1, 2021 Accepting new patients

Locations

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 363-1515

Interoperability endpoints

  • Direct secure messaging: jstahl@gppc.medentdirect.com

Organizations & group practices 1

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1023399870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S FRONT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGH ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031126",
            "telephone_number": "716-859-7937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4300 Londonderry Rd",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171095317",
            "country_code": "US",
            "telephone_number": "717-231-8772",
            "fax_number": "717-231-8435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAHL",
        "first_name": "JEFFERY",
        "middle_name": "DAVID",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-07",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS016611",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "299656",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NY",
            "license": "299656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.