NPIMap

Individual provider Active NPI

Michael Terence Stanger, MD

  • Psychiatry Physician
  • Boulder, CO
National Provider Identifier
1477746675
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
DR.0064896 Issued in CO
Practice address
4801 Riverbend Rd Ste 120a
Boulder, CO 80301-2613
Phone
(303) 415-8641
NPI assigned
Aug 21, 2007
Last updated
Oct 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ML20009087 WA
Psychiatry Physician 2084P0800X A116861 CA
Psychiatry Physician 2084P0800X DR.0064896 CO Primary

Addresses

Primary practice location

4801 Riverbend Rd Ste 120a
Boulder, CO 80301-2613

Mailing address

6333 Telegraph Ave Ste 201
Oakland, CA 94609-1359
Phone (510) 859-8127

Other practice location 1

2625 Alcatraz Ave
Suite 271
Berkeley, CA 94705
Phone (206) 543-0065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120508000093 CA Practitioner - Psychiatry 0345402434 Reassigns benefits to 1 organization
I20201014002354 CO Practitioner - Psychiatry 0345402434 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
New York University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

4801 Riverbend Rd
Boulder, CO 80301-2613

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A116861CAMDPsychiatry Physician
DR.0064896COMDPsychiatry Physician
ML20009087WAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Psychiatric Associates Psychiatry CurrentSince Feb 14, 2017 Accepting new patients
Denver Health and Hospital Authority CurrentSince Nov 1, 2020 Accepting new patients
Boulder Community Health CurrentSince Oct 9, 2022 Accepting new patients
Denver Health and Hospital Authority CurrentSince Nov 1, 2020 Accepting new patients
Boulder Community Health CurrentSince Oct 9, 2022 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

2001 Dwight Way
Fl 4
Berkeley, CA 94704
Phone (510) 204-2461

2001 Dwight Way
Rm 4190
Berkeley, CA 94704
Phone (510) 204-4635

2020 Milvia St
Ste 440
Berkeley, CA 94704
Phone (510) 204-4635

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

4801 Riverbend Rd
Ste 120A
Boulder, CO 80301
Phone (303) 415-4299

4801 Riverbend Rd
Ste 300
Boulder, CO 80301
Phone (303) 415-8621

777 Bannock St
Denver, CO 80204

Organizations & group practices 10

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.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1477746675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 TELEGRAPH AVE STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091359",
            "telephone_number": "510-859-8127",
            "fax_number": "510-590-9953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 RIVERBEND RD STE 120A",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012613",
            "telephone_number": "303-415-8641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2625 Alcatraz Ave",
            "address_2": "Suite 271",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "94705",
            "country_code": "US",
            "telephone_number": "206-543-0065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANGER",
        "first_name": "MICHAEL",
        "middle_name": "TERENCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-21",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "ML20009087",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A116861",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR.0064896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.