Individual provider Active NPI

Douglas Gary Stazer Jr., CRNP

  • Family Nurse Practitioner
  • Erie, PA
National Provider Identifier
1376307090
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP029026 Issued in PA
Practice address
4950 Buffalo Rd
Erie, PA 16510-2304
Phone
(814) 899-7000
Fax
(814) 899-0334
NPI assigned
Feb 13, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP029026 PA Primary

Addresses

Primary practice location

4950 Buffalo Rd
Erie, PA 16510-2304

Mailing address

4950 Buffalo Rd
Erie, PA 16510-2304
Phone (814) 899-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240320002893 PA Practitioner - Nurse Practitioner 0941647309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4950 Buffalo Rd
Erie, PA 16510-2304
Phone (814) 899-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Medical Education and Research Institute Inc CurrentSince Feb 10, 2024 Accepting new patients
Multi-Cultural Health Evaluation Delivery Systems Inc CurrentSince Sep 15, 2025 Accepting new patients
Saint Vincent Consultants in Cardiovascular Diseases Past Accepting new patients

Locations

155 E State St
Albion, PA 16401
Phone (814) 756-4917

2314 Sassafras St
Ste 2
Erie, PA 16502
Phone (814) 452-5105

2928 Peach St
Erie, PA 16508
Phone (814) 452-6229

2021 E 20th St
Erie, PA 16510
Phone (814) 453-6229

4950 Buffalo Rd
Erie, PA 16510
Phone (814) 898-2576

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1376307090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 BUFFALO RD",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165102304",
            "telephone_number": "814-899-7000",
            "fax_number": "814-899-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 BUFFALO RD",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165102304",
            "telephone_number": "814-899-7000",
            "fax_number": "814-899-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAZER",
        "first_name": "DOUGLAS",
        "middle_name": "GARY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP029026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.