Individual provider Active NPI

Hollis Taggart Stahl, PA-C

  • Physician Assistant
  • La Mesa, CA
National Provider Identifier
1417316696
Registry record updated May 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54043 Issued in CA
Practice address
5525 Grossmont Center Dr
La Mesa, CA 91942-3009
Phone
(619) 644-6705
NPI assigned
Feb 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54043 CA Primary

Addresses

Primary practice location

5525 Grossmont Center Dr
La Mesa, CA 91942-3009

Mailing address

5651 Copley Dr
San Diego, CA 92111-7903
Phone (858) 262-6344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20221212003136 NC Practitioner - Physician Assistant 3678870235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone (828) 213-1740

2000 Health Park Dr
Brentwood, TN 37027-4692

5 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone (828) 213-1740

509 Biltmore Ave
Asheville, NC 28801-4601
Phone (828) 213-2325

7 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone (828) 213-1740

9 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone (828) 213-1740

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.39 of 100Reported as apm
Quality
77.7
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1149NHMDClinical Psychologist
54043CAMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mission Community Anesthesiology Specialists LLC CurrentSince Nov 7, 2022 Accepting new patients

Locations

509 Biltmore Ave
Asheville, NC 28801
Phone (828) 213-2325

1 Hospital Dr
Ste 3200
Asheville, NC 28801
Phone (828) 213-4639

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589328000000",
    "number": "1417316696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5651 COPLEY DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-262-6344",
            "fax_number": "858-626-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423009",
            "telephone_number": "619-644-6705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "HOLLIS",
        "middle_name": "TAGGART",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-17",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.