Active NPI
Stacey J.P. Memberg, MD
- Pediatrics Physician
- Medina, OH
National Provider Identifier
1235235003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35077164
- Practice address
- 4015 Medina Rd Ste 50
Medina, OH 44256-5970 - Phone
- (330) 723-7005
- Fax
- (330) 723-4854
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35077164 | OH | Primary |
Addresses
Primary practice location
4015 Medina Rd Ste 50
Medina, OH 44256-5970
Mailing address
PO Box 8792
Belfast, ME 04915-8792
Phone (300) 723-7005
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2196565 | Medicaid | OH |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35077164 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| University Primary Care Practices | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- smemberg36986@ehrdirect.uhhospitals.org
Organizations & group practices 2
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.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Pediatrics Physician
- Twinsburg, OH
- NPI 1326166752
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311638400000",
"number": "1235235003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8792",
"city": "BELFAST",
"state": "ME",
"postal_code": "049158792",
"telephone_number": "300-723-7005",
"fax_number": "330-723-4854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4015 MEDINA RD STE 50",
"city": "MEDINA",
"state": "OH",
"postal_code": "442565970",
"telephone_number": "330-723-7005",
"fax_number": "330-723-4854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEMBERG",
"first_name": "STACEY",
"middle_name": "J.P.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2011-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35077164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2196565",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.