NPIMap

Individual provider Active NPI

Ilya Stone, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Rolla, MO
National Provider Identifier
1295717346
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD00038295 Issued in WA
Practice address
1000 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 458-7050
Fax
(573) 458-8399
NPI assigned
Nov 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD00038295 WA Primary

Addresses

Primary practice location

1000 W 10TH St
Rolla, MO 65401-2905

Mailing address

14275 Midway Rd Ste 400
Addison, TX 75001-3661
Phone (206) 622-7747

Other identifiers 3

IdentifierTypeStateIssuer
0189042OtherWA ST LABOR & INDUSTRIES
0189063OtherWA ST LABOR & INDUSTRIES
8248676MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20210628000810 MO Practitioner - Pathology 4789639436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Mississippi School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ameripath Indianapolis PC 35 clinicians

Practice addresses (Care Compare)

1000 W 10TH St
Rolla, MO 65401-2905
Phone (573) 458-7050

Hospital & facility affiliations

  • Phelps County Regional Medical Center Hospital, Rolla, MO, CCN 260017
  • Salem Memorial District Hospital Hospital, Salem, MO, CCN 261318
  • Texas County Memorial Hospital Hospital, Houston, MO, CCN 260024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00038295WAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ameripath Indianapolis PC Anatomic Pathology & Clinical Pathology CurrentSince May 7, 2025 Accepting new patients
Mid-Columbia Medical Center Past Accepting new patients
Puget Sound Institute of Pathology, PLLC Past Accepting new patients
Puget Sound Institute of Pathology PLLC Past Accepting new patients

Locations

13179 Collections Ctr Dr
Chicago, IL 60693

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

14275 Midway Rd
Ste 400
Addison, TX 75001
Phone (214) 932-8018

Organizations & group practices 8

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.

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1295717346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD STE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013661",
            "telephone_number": "206-622-7747",
            "fax_number": "610-271-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-458-7050",
            "fax_number": "573-458-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONE",
        "first_name": "ILYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD00038295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA ST LABOR & INDUSTRIES",
            "identifier": "0189042",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA ST LABOR & INDUSTRIES",
            "identifier": "0189063",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8248676",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.