Individual provider Active NPI

George W. Stern, PH.D.

  • Psychologist
  • Lawrence, KS
National Provider Identifier
1063504900
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
750 Issued in KS
Practice address
3200 Mesa Way Ste D
Lawrence, KS 66049-2343
Phone
(785) 760-3457
NPI assigned
Sep 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 750 KS Primary

Addresses

Primary practice location

3200 Mesa Way Ste D
Lawrence, KS 66049-2343

Mailing address

4111 W 12TH St
Lawrence, KS 66049-3511
Phone (785) 841-0724

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 Philosophy

State licenses

LicenseStateTypeSpecialty
750KSMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mind-Body Health Professionals, P.a. Past Accepting new patients
Mahasen T Desilva 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063504900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 W 12TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660493511",
            "telephone_number": "785-841-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MESA WAY STE D",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660492343",
            "telephone_number": "785-760-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STERN",
        "first_name": "GEORGE",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, KS

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.

Verify at the official NPI Registry.