Active NPI
David Thomas Stacy, P.A
- Physician Assistant
- Fremont, CA
National Provider Identifier
1427096783
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Dec 20, 2010.
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16421
- Practice address
- 3161 Walnut Ave
Fremont, CA 94538-2216 - Phone
- (510) 796-1000
- Fax
- (510) 796-1050
- NPI assigned
- Jun 2, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16421 | CA | Primary |
Addresses
Primary practice location
3161 Walnut Ave
Fremont, CA 94538-2216
Mailing address
141 Embarcadero W
Apt 4319
Oakland, CA 94607-3719
Phone (510) 282-1335
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA16421 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427096783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 EMBARCADERO W",
"address_2": "APT 4319",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946073719",
"telephone_number": "510-282-1335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3161 WALNUT AVE",
"city": "FREMONT",
"state": "CA",
"postal_code": "945382216",
"telephone_number": "510-796-1000",
"fax_number": "510-796-1050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "DAVID",
"middle_name": "THOMAS",
"credential": "P.A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA16421",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.