Active NPI
Jerrel L Stanley, MD
- Family Medicine Physician
- Germantown, WI
National Provider Identifier
1073547949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22544
- Practice address
- N112 W 17975 Mequon Road
Germantown, WI 53022 - Phone
- (262) 532-7600
- Fax
- (262) 532-7602
- NPI assigned
- Jul 10, 2006
- Last updated
- Dec 29, 2010
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 22544 | WI | Primary |
Addresses
Primary practice location
N112 W 17975 Mequon Road
Germantown, WI 53022
Mailing address
3003 W Good Hope Road
Milwaukee, WI 53209
Phone (414) 352-3100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30387500 | Medicaid | WI | |
| P00451316 | Other | WI | RR MEDICARE |
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 |
|---|---|---|---|
| 22544 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Healthcare SC | Family Medicine | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293580800000",
"number": "1073547949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 W GOOD HOPE ROAD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53209",
"telephone_number": "414-352-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N112 W 17975 MEQUON ROAD",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "53022",
"telephone_number": "262-532-7600",
"fax_number": "262-532-7602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "JERREL",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2010-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "22544",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30387500",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00451316",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Germantown, WI
- Jill Spielmann, LPC
- Sports Physical Therapy & Rehab Specialist, S.C. (Athletico Physical Therapy)
- Rachel Lynn Squibb
- SSC Germantown Operating Company LLC (Virginia Highlands Health and Rehabilitation Center)
- Angela C Stanley, PSY.D.
- Melanie Steffens, PHARMD
- Victoria (Vicki) Dawn Stoddart Walther, LMT
- Stoeckl Family Dentistry, SC
- Clemens K Stoeckl, D.D.S
- April A Stolte, OTR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.