Active NPI
Anthony John Stark, LPTA
- Skilled Nursing Facility
- Swansea, IL
National Provider Identifier
1306119102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 2067563
- Practice address
- 3751 Round Hill Rd
Apt 5
Swansea, IL 62226-1222 - Phone
- (469) 939-6867
- NPI assigned
- Feb 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 160.005649 | IL | |
| Physical Therapy Assistant | 225200000X | 2067563 | TX | |
| Skilled Nursing Facility | 314000000X | 2067563 | TX | Primary |
Addresses
Primary practice location
3751 Round Hill Rd
Apt 5
Swansea, IL 62226-1222
Mailing address
3751 Round Hill Rd
Apt 5
Swansea, IL 62226-1222
Phone (469) 939-6867
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2067563 | TX | MD | Physical Therapy Assistant |
| 160.005649 | IL | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739491200000",
"number": "1306119102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3751 ROUND HILL RD",
"address_2": "APT 5",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622261222",
"telephone_number": "469-939-6867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3751 ROUND HILL RD",
"address_2": "APT 5",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622261222",
"telephone_number": "469-939-6867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "ANTHONY",
"middle_name": "JOHN",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-10",
"last_updated": "2025-02-14",
"certification_date": "2025-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "IL",
"license": "160.005649",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2067563",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "TX",
"license": "2067563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
- SSM Medical Group (Belleville Pediatrics)
- St .Clair Pedaitrics, LLC
- St Clair Orthopedics, SC
- St Clair Orthopedics, SC
- Jason L Stanczyk, D.M.D., M.S.
- Stephanie Henson, MSW, LCSW, LLC
- Steven Connolly, DMD, PC (Executive Woods Dental Care, Inc.)
- Stephanie Stock
- Christy Elizabeth Stratman, PHARMD
- James K Stubblefield, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.