Active NPI
Sean M Stadtlander, MD
- Internal Medicine Physician
- Newberg, OR
National Provider Identifier
1104859511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD19575
- Practice address
- 1003 Providence Dr
Suite 210
Newberg, OR 97132-7521 - Phone
- (503) 537-5900
- Fax
- (503) 537-5959
- NPI assigned
- Jul 9, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD19575 | OR | Primary |
Addresses
Primary practice location
1003 Providence Dr
Suite 210
Newberg, OR 97132-7521
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00200689 | Other | OR | RR MEDICARE |
| 076922 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sstadtlander117623@oc.providencedirect.org |
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 |
|---|---|---|---|
| 19575 | OR | MD | Massage Therapist |
Interoperability endpoints
- sstadtlander117623@oc.providencedirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1104859511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 PROVIDENCE DR",
"address_2": "SUITE 210",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971327521",
"telephone_number": "503-537-5900",
"fax_number": "503-537-5959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STADTLANDER",
"first_name": "SEAN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD19575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00200689",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "076922",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sstadtlander117623@oc.providencedirect.org",
"affiliation": "N",
"address_1": "1000 N Providence Dr Ste 120",
"city": "Newberg",
"state": "OR",
"country_code": "US",
"postal_code": "971327582",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.