NPIMap

Organization Active NPI

Stall Senior Medical LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Getzville, NY
National Provider Identifier
1104087915
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
163872 Issued in NY
Legal business name
STALL SENIOR MEDICAL LLC
Practice address
97 King Anthony Way
Getzville, NY 14068-1413
Phone
(716) 861-1312
Fax
(888) 976-5853
NPI assigned
Jun 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Robert Stall, MDNPI 1205822202
Title
Owner/Ceo
Phone
(716) 861-1312

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X 163872 NY Primary

Addresses

Primary practice location

97 King Anthony Way
Getzville, NY 14068-1413

Mailing address

97 King Anthony Way
Getzville, NY 14068-1413
Phone (716) 861-1312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080723000652 NY Part B Supplier - Clinic/Group Practice 2365515384 Receives reassigned benefits from 9 practitioners
Practice locations: Amherst, NY

National Provider Directory

National Provider Directory

Locations

2425 Sweet Home Rd
Ste B
Amherst, NY 14228
Phone (716) 609-9141

4242 Ridge Lea Rd
Ste 26
Buffalo, NY 14226
Phone (716) 213-4345

4248 Ridge Lea Rd
Ste 126
Buffalo, NY 14226
Phone (716) 833-3237

6722 Erie Rd
Derby, NY 14047
Phone (716) 947-2097

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1104087915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 KING ANTHONY WAY",
            "city": "GETZVILLE",
            "state": "NY",
            "postal_code": "140681413",
            "telephone_number": "716-861-1312",
            "fax_number": "888-976-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 KING ANTHONY WAY",
            "city": "GETZVILLE",
            "state": "NY",
            "postal_code": "140681413",
            "telephone_number": "716-861-1312",
            "fax_number": "888-976-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STALL SENIOR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "STALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "716-861-1312",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "163872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Getzville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.