NPIMap

Individual provider Active NPI

Benjamin Adam Stahl, M.D.

  • Family Medicine Physician
  • Boerne, TX
National Provider Identifier
1104958230
Registry record updated May 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N1905 Issued in TX
Practice address
1430 South Main Street
Suite 111
Boerne, TX 78006
Phone
(830) 331-8585
Fax
(830) 331-8586
NPI assigned
Mar 12, 2007
Last updated
May 10, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10025929 TX
Student in an Organized Health Care Education/Training Program 390200000X N1905 TX
Family Medicine Physician 207Q00000X N1905 TX Primary

Addresses

Primary practice location

1430 South Main Street
Suite 111
Boerne, TX 78006

Mailing address

1430 South Main Street
Suite 111
Boerne, TX 78006
Phone (830) 331-8585

Other identifiers 1

IdentifierTypeStateIssuer
01287686MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091102000307 TX Practitioner - Family Practice 2769529296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

112 Herff Rd
Suite 110
Boerne, TX 78006-2751
Phone (830) 331-8585

17510 W Grand Pkwy S
Sugar Land, TX 77479-2649

7900 Fannin St
Suite 4000
Houston, TX 77054-2935
Phone (713) 512-7500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N1905TXMDFamily Medicine Physician
BP10025929TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Gulf Coast PLLC CurrentSince Oct 6, 2023 Accepting new patients
Privia Medical Group Gulf Coast, PLLC CurrentSince Oct 6, 2023 Accepting new patients

Locations

112 Herff Rd
Ste 110
Boerne, TX 78006
Phone (830) 331-8181

646 FM 517 Rd W
Dickinson, TX 77539
Phone (281) 309-9001

7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027

10970 Shadow Creek Pkwy
Ste 100
Pearland, TX 77584
Phone (281) 398-8500

17510 W Grand Pkwy S
Ste 430
Sugar Land, TX 77479
Phone (713) 578-3820

Interoperability endpoints

  • Direct secure messaging: benjamin.stahl.1@8042.direct.athenahealth.com
  • Direct secure messaging: bstahl0@yourcarecommunity.org

Organizations & group practices 3

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273449600000",
    "number": "1104958230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 SOUTH MAIN STREET",
            "address_2": "SUITE 111",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78006",
            "telephone_number": "830-331-8585",
            "fax_number": "830-331-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 SOUTH MAIN STREET",
            "address_2": "SUITE 111",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78006",
            "telephone_number": "830-331-8585",
            "fax_number": "830-331-8586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "BENJAMIN",
        "middle_name": "ADAM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2010-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10025929",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "N1905",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N1905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01287686",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boerne, TX

Sources for this page

Verify at the official NPI Registry.