Theodore Edmund Staahl, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G037452 Issued in CA

Practice address

1329 Spanos CT Ste a-1
Modesto, CA 95355-2806

Phone

(209) 577-5700

Fax

(209) 577-5968

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Otolaryngology

Education

Other, 1971

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1295896041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 SPANOS CT STE A-1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552806",
            "telephone_number": "209-577-5700",
            "fax_number": "209-577-5968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 SPANOS CT STE A-1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552806",
            "telephone_number": "209-577-5700",
            "fax_number": "209-577-5968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAAHL",
        "first_name": "THEODORE",
        "middle_name": "EDMUND",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G037452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chaithra Sreenath, MD
• Mahathep Matthew Srikureja, D.O.
• Sol Srouji, CRNFA
• Beatrice St Claire, M.D.
• St Pauls Modesto LP
• Thuy Staats, NP
• Claudia Stacey
• James Dean Stalians, AGNP
• Bonnie Sue Stallings
• Laura A. Stallone, MD

• Specialist in Modesto, CA
• Providers in Modesto, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.