Active NPI
Stanley Dean Skaggs, MD
- Cardiovascular Disease Physician
- San Diego, CA
National Provider Identifier
1407960362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- G39245
- Practice address
- 3525 Del Mar Heights Rd
282
San Diego, CA 92130-2122 - Phone
- (858) 554-0120
- NPI assigned
- Aug 18, 2006
- 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 |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | G39245 | CA | Primary |
Addresses
Primary practice location
3525 Del Mar Heights Rd
282
San Diego, CA 92130-2122
Mailing address
3525 Del Mar Heights Rd
282
San Diego, CA 92130-2122
Phone (858) 554-0120
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G392450 | Other | CA | BLUE SHIELD |
| 3291421 | Other | CIGNA | |
| DN722Z | Other | CA | MEDICARE PTAN |
| 0004125760 | Other | AETNA | |
| 330898160 920370000 | Other | TRICARE | |
| 00G392450 | Medicaid | CA | |
| 330898160 | Other | CA | BLUE CROSS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363737600000",
"number": "1407960362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 DEL MAR HEIGHTS RD",
"address_2": "282",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302122",
"telephone_number": "858-554-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 DEL MAR HEIGHTS RD",
"address_2": "282",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302122",
"telephone_number": "858-554-0120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKAGGS",
"first_name": "STANLEY",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2013-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "G39245",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00G392450",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3291421",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "DN722Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0004125760",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "330898160 920370000",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G392450",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "330898160",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.