NPIMap

Individual provider Active NPI

Vance Rudy Stouffer Jr., MD

  • Family Medicine Physician
  • Etters, PA
National Provider Identifier
1326073388
Registry record updated Feb 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD010245E Issued in PA
Practice address
786 Cartref Rd
Etters, PA 17319-9640
Phone
(717) 938-6122
NPI assigned
Jul 11, 2006
Last updated
Feb 23, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD010245E PA Primary

Addresses

Primary practice location

786 Cartref Rd
Etters, PA 17319-9640

Mailing address

786 Cartref Rd
Etters, PA 17319-9640

Other identifiers 8

IdentifierTypeStateIssuer
0068747000OtherPAAMERIHEALTH 65 PA
613926OtherMDCAREFIRST MD BCBS
080176705OtherPARAILROAD MEDICARE
10226OtherPAGEISINGER
4257548OtherPAAETNA
011227OtherPAJOHNS HOPKINS
000589158MedicaidPA
047575OtherPAHIGHMARK BLUE SHIELD

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD010245EPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Past Accepting new patients
Wellspan Medical Group Family Medicine Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1326073388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "786 CARTREF RD",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "786 CARTREF RD",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199640",
            "telephone_number": "717-938-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUFFER",
        "first_name": "VANCE",
        "middle_name": "RUDY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD010245E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH 65 PA",
            "identifier": "0068747000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "613926",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080176705",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "10226",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4257548",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHNS HOPKINS",
            "identifier": "011227",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000589158",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "047575",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Etters, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.