Active NPI
Phillip Clayon Stafford
- Rehabilitation Practitioner
- Las Vegas, NV
National Provider Identifier
1376083220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 7213 Chesterton Dr
Las Vegas, NV 89128-3121 - Phone
- (702) 754-9136
- NPI assigned
- Feb 26, 2017
- Last updated
- Aug 5, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | NU | Primary |
Addresses
Primary practice location
7213 Chesterton Dr
Las Vegas, NV 89128-3121
Mailing address
7055 E Lake Mead Blvd
Apt 1004
Las Vegas, NV 89156-1108
Phone (804) 729-1264
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth Moving Forward LLC | Single Specialty | Current | Accepting new patients |
| Impact Wellness Center LLC | Current | Accepting new patients | |
| Choice Group LLC | Current | Accepting new patients |
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.
-
- Mental Health Counselor
- North Chesterfield, VA
- NPI 1205509205
-
- Community/Behavioral Health Agency
- Las Vegas, NV
- NPI 1720584295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628121600000",
"number": "1376083220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7055 E LAKE MEAD BLVD",
"address_2": "APT 1004",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891561108",
"telephone_number": "804-729-1264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7213 CHESTERTON DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891283121",
"telephone_number": "702-754-9136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "PHILLIP",
"middle_name": "CLAYON",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-26",
"last_updated": "2021-08-05",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.