NPIMap

Individual provider Active NPI

Stanford T Prescott Jr., MD

  • Anesthesiology Physician
  • Woodway, TX
National Provider Identifier
1174527600
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00030232 Issued in WA
Practice address
1001 Camden CT
Woodway, TX 76712-8566
Phone
(253) 678-9830
NPI assigned
Jun 13, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00030232 WA Primary
Anesthesiology Physician 207L00000X 01070563A IN
Anesthesiology Physician 207L00000X 30862 OK

Addresses

Primary practice location

1001 Camden CT
Woodway, TX 76712-8566

Mailing address

1001 Camden CT
Woodway, TX 76712-8566
Phone (253) 678-9830

Other identifiers 1

IdentifierTypeStateIssuer
1118132MedicaidWA

Other names 1

  • Stanford T Prescott Other name

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

LicenseStateTypeSpecialty
30862OKMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ashland Anesthesia, P.S.C. Anesthesiology Past Accepting new patients
Tri-State Anesthesiology, PSC Anesthesiology PastSince Oct 8, 2001 Accepting new patients
Preferred Anesthesia Consultants, P.C. Anesthesiology Past Accepting new patients
Stanford Prescott MD PLLC Anesthesiology PastSince Apr 13, 2005 Accepting new patients
Parkview Health System Inc Anesthesiology Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1174527600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CAMDEN CT",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767128566",
            "telephone_number": "253-678-9830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CAMDEN CT",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767128566",
            "telephone_number": "253-678-9830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESCOTT",
        "first_name": "STANFORD",
        "middle_name": "T",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00030232",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01070563A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "30862",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1118132",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STANFORD",
            "last_name": "PRESCOTT",
            "middle_name": "T",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woodway, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; 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.