Active NPI
Phillip Stout, MD
- Emergency Medicine Physician
- Middleburg Heights, OH
National Provider Identifier
1063457224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 35042083S
- Practice address
- 18697 Bagley Rd
Middleburg Heights, OH 44130-3417 - Phone
- (440) 816-8000
- NPI assigned
- Jun 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 35042083S | OH | Primary |
Addresses
Primary practice location
18697 Bagley Rd
Middleburg Heights, OH 44130-3417
Mailing address
17650 Parkland Dr
Shaker Heights, OH 44120-2549
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0378569 | Medicaid | OH | |
| 942460636344 | Other | OH | CARESOURCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35042083S | OH | MD | Emergency Medicine Physician |
Interoperability endpoints
- pstout@direct.swgeneral.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063457224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17650 PARKLAND DR",
"city": "SHAKER HEIGHTS",
"state": "OH",
"postal_code": "441202549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18697 BAGLEY RD",
"city": "MIDDLEBURG HEIGHTS",
"state": "OH",
"postal_code": "441303417",
"telephone_number": "440-816-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "PHILLIP",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OH",
"license": "35042083S",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0378569",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "942460636344",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Middleburg Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.