NPIMap

Individual provider Active NPI

Stan A Eisele, MD

  • Internal Medicine Physician
  • Eagle, ID
National Provider Identifier
1306886767
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M8628 Issued in ID
Practice address
323 E Riverside Dr Ste 224
Eagle, ID 83616
Phone
(208) 302-6000
Fax
(208) 302-6055
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M8628 ID Primary

Addresses

Primary practice location

323 E Riverside Dr Ste 224
Eagle, ID 83616

Mailing address

3340 E Goldstone Way
Meridian, ID 83642
Phone (208) 302-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20040621001692 ID Practitioner - Internal Medicine 2668457946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Southern California Keck School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3025 W Cherry LN
Meridian, ID 83642-8531

323 E Riverside Dr
Suite 224
Eagle, ID 83616-6865
Phone (208) 302-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8628IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 21, 2009 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 21, 2009 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Internal Medicine Past Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

315 E Elm St
Ste 100
Caldwell, ID 83605
Phone (208) 302-7100

323 E Riverside Dr
Ste 224
Eagle, ID 83616
Phone (208) 302-6000

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

Organizations & group practices 4

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 9

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1306886767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-302-6000",
            "fax_number": "208-302-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E RIVERSIDE DR STE 224",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-302-6000",
            "fax_number": "208-302-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISELE",
        "first_name": "STAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M8628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.