Peter Stach, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

DP198085 Issued in OR

Practice address

4770 SW Watson Ave
Beaverton, OR 97005-0511

Phone

(503) 805-4720

Fax

(971) 223-0969

NPI assigned

Jul 18, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Western Un of HLTH Sciences, Col of Podiatric Med, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bridge City Foot and Ankle LLCGroup PAC ID 3577975762, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bridge City Foot & Ankle LLC

  • Podiatrist
  • Beaverton, OR
  • NPI 1669074316

  OR, Podiatrist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1366965675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 SW WATSON AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970050511",
            "telephone_number": "503-805-4720",
            "fax_number": "971-223-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 SW WATSON AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970050511",
            "telephone_number": "503-805-4720",
            "fax_number": "971-223-0969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACH",
        "first_name": "PETER",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-06-27",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP198085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500798722",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dr.stach@bcfaa.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "4770 SW Watson Ave",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970050511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Beaverton, OR
• Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.