Jeffrey Standage, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D009457 Issued in AZ

Practice address

104 Medicine Way
Peridot, AZ 85542-0000

Phone

(928) 475-1480

NPI assigned

Jul 1, 2016

Last updated

Oct 21, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• San Carlos Apache Healthcare Corporation

  • Critical Access Hospital Clinic/Center
  • Peridot, AZ
  • NPI 1265813075

  TX

  Medicare reassignment NPD
• San Carlos Apache Healthcare Corporation

  dba Clarence Wesley Health Center

  • Clinic/Center
  • Bylas, AZ
  • NPI 1417330713
  NPD

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

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1093167041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MEDICINE WAY",
            "city": "PERIDOT",
            "state": "AZ",
            "postal_code": "855420000",
            "telephone_number": "928-475-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MEDICINE WAY",
            "city": "PERIDOT",
            "state": "AZ",
            "postal_code": "855420000",
            "telephone_number": "928-475-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANDAGE",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-01",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Carlos Apache Healthcare Corporation
• Tamara Scott, RDN
• Anna Serey, OTR/L
• Rachel Ann Shorthouse, MPH, MS, RD
• Gary Simmons
• Brenda Stevens
• Dorothea Blanche Stevens, RN
• Nalani Ann Stevens
• Pamela N Tambi, PHARMACIST
• Katherine Elaine Tavares, FNP-BC

• Dentist in Peridot, AZ
• Providers in Peridot, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; 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.

Verify at the official NPI Registry.