Active NPI
Xavier Rajagopal Stacey, M.D.
- Internal Medicine Physician
- Portland, OR
National Provider Identifier
1033523337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- PG169255
- Practice address
- 9205 SW Barnes Rd
Suite 20
Portland, OR 97225-6603 - Phone
- (503) 216-2229
- NPI assigned
- Jun 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | PG169255 | OR | Primary |
Addresses
Primary practice location
9205 SW Barnes Rd
Suite 20
Portland, OR 97225-6603
Mailing address
9205 SW Barnes Rd
Suite 20
Portland, OR 97225-6603
Phone (503) 216-2229
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PG169255 | Other | OR | OREGON M.D. LIMITED LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PG169255 | OR | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402617600000",
"number": "1033523337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9205 SW BARNES RD",
"address_2": "SUITE 20",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256603",
"telephone_number": "503-216-2229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9205 SW BARNES RD",
"address_2": "SUITE 20",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256603",
"telephone_number": "503-216-2229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACEY",
"first_name": "XAVIER",
"middle_name": "RAJAGOPAL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-13",
"last_updated": "2014-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "PG169255",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON M.D. LIMITED LICENSE",
"identifier": "PG169255",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.