Active NPI
David Bernard Staab, M.D.
- Surgery Physician
- Lenoir City, TN
National Provider Identifier
1326155292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD35862
- Practice address
- 576 Fort Loudoun Medical Center Dr
#101
Lenoir City, TN 37772-5676 - Phone
- (865) 690-5263
- NPI assigned
- Aug 24, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD35862 | TN | Primary |
Addresses
Primary practice location
576 Fort Loudoun Medical Center Dr
#101
Lenoir City, TN 37772-5676
Mailing address
Dept 888067
Knoxville, TN 37995-8067
Phone (865) 588-8838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3870535 | Medicaid | TN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| MD35862 | TN | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Tennessee Surgical Group, P.C. | Past | Accepting new patients | |
| Premier Surgical Associates, PLLC | Surgery | Past | Accepting new patients |
| Premier Surgical Associates, PLLC | Surgery | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71045
Organizations & group practices 3
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.
-
- Specialist
- Knoxville, TN
- NPI 1164589628
-
- Surgery Physician
- Knoxville, TN
- NPI 1750449443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326155292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT 888067",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379958067",
"telephone_number": "865-588-8838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "576 FORT LOUDOUN MEDICAL CENTER DR",
"address_2": "#101",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377725676",
"telephone_number": "865-690-5263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAAB",
"first_name": "DAVID",
"middle_name": "BERNARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TN",
"license": "MD35862",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3870535",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lenoir City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.