Individual provider Active NPI

Jeff Edward Stanton, CCP

  • Perfusionist
  • San Francisco, CA
National Provider Identifier
1104338540
Registry record updated Oct 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PerfusionistTaxonomy code 242T00000X
License
000063
Practice address
1975 4TH St
San Francisco, CA 94143-2351
Phone
(415) 476-0567
NPI assigned
Oct 25, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Perfusionist 242T00000X 000063 Primary

Addresses

Primary practice location

1975 4TH St
San Francisco, CA 94143-2351

Mailing address

119 Berendos Ave
Pacifica, CA 94044-3109
Phone (415) 713-4591

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)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508889600000",
    "number": "1104338540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BERENDOS AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940443109",
            "telephone_number": "415-713-4591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 4TH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432351",
            "telephone_number": "415-476-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANTON",
        "first_name": "JEFF",
        "middle_name": "EDWARD",
        "credential": "CCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-25",
        "last_updated": "2017-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": null,
            "license": "000063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; 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.