Individual provider Active NPI

Staci M Paul, M.D.

  • Gynecology Physician
  • Reno, NV
National Provider Identifier
1174528277
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
8965 Issued in NV
Practice address
635 Innovation Dr Ste 300
Reno, NV 89511-2215
Phone
(775) 329-6241
Fax
(775) 329-4921
NPI assigned
Jun 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 8965 NV Primary
Obstetrics & Gynecology Physician 207V00000X 8965 NV
Obstetrics & Gynecology Physician 207V00000X G080176 CA

Addresses

Primary practice location

635 Innovation Dr Ste 300
Reno, NV 89511-2215

Mailing address

635 Innovation Dr Ste 300
Reno, NV 89511-2215
Phone (775) 329-6241

Other identifiers 1

IdentifierTypeStateIssuer
002016794MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 28, 2015 through Jan 28, 2027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G080176CAMDObstetrics & Gynecology Physician
8965NVMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
OB-GYN Associates LTD Obstetrics & Gynecology Past Accepting new patients

Organizations & group practices 1

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": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1174528277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 INNOVATION DR STE 300",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112215",
            "telephone_number": "775-329-6241",
            "fax_number": "775-329-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 INNOVATION DR STE 300",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112215",
            "telephone_number": "775-329-6241",
            "fax_number": "775-329-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "STACI",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-15",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NV",
            "license": "8965",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NV",
            "license": "8965",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G080176",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002016794",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.