Stallant Medical Group Inc
Organization Active NPI Rural Health Clinic/Center · Highland, CA
NPI 1508683111 · NPPES record last updated Nov 14, 2025
Key facts
- NPI
- 1508683111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- STALLANT MEDICAL GROUP INC
- Practice address
- 27811 Greenspot Rd
Highland, CA 92346-4361 - Phone
- (912) 347-3974
- NPI assigned
- Sep 24, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- STALLANT MEDICAL GROUP INC
Authorized official
- Name
- Robert Forrest Steffens
- Title
- Coo
- Phone
- (909) 443-2584
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 24
-
Heather Blankenship, MFT
-
Allen Bracebridge, APRN, FNP-C
-
Sophia Chun, MD
-
Tracy David Cole, D.C.
-
Brian Glass, FNP
-
Daphne L. Huang, D.P.M.
-
Nicole Laferriere, LCSW
-
Matthew McNeese, DNP, FNP-C
-
Rachel Satoh, APRN; FNP-C
-
Colby Austin Strong, PA-C
-
Zachary Holbert, FNP-BC
-
Patricia Sternenberg, FNP-BC
-
Yasmin Chene, PA
-
Steven Clark Gawthrop, P.A.
-
Holly Gauthun, RDN
-
Matthew Hamerly, PT
-
Aliyah Simcoff, LCSW
-
Roger D Gallant, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2319383 | Stallant Health & Wellness | Certificate of waiver | Feb 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Rural health clinic certification: CCN 558920
- Legal name
- STALLANT MEDICAL GROUP INC
- Doing business as
- STALLANT HEALTH & WELLNESS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 24, 2025
- Last certification
- Jun 24, 2025
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 27811 Greenspot Rd
Ste a
Highland, CA 92346-4361
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Randall Steffens II |
Corporate Officer |
Nov 7, 2019 | |
| Robert Steffens |
Corporate Officer |
Nov 7, 2019 | |
| Joshua Nebblett |
Corporate Officer |
Nov 7, 2019 | |
| Linda Steffens |
Corporate Officer |
Nov 7, 2019 | |
| Richard Steffens |
Corporate Officer |
Nov 7, 2019 | |
| Randall L Steffens |
5% Or Greater Direct Ownership Interest | Nov 7, 2019 | 100% |
| Corporate Officer |
Nov 7, 2019 | ||
| Corporate Director | Nov 7, 2019 | 100% | |
| W-2 Managing Employee |
Nov 7, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250212000720 | CA | Part a Provider - Rural Health Clinic | 6406283845 | Practice locations: Highland, CA |
| O20251229000818 | CA | Part B Supplier - Clinic/Group Practice | 6406283845 |
Receives reassigned benefits from 22 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Highland, CA; Crescent City, CA |
National Provider Directory
- Tax ID family
- Stallant Health Wellness
- Part of
- Stallant Health Wellness
Locations
515 E Washington Blvd
Crescent City, CA 95531
Phone (707) 460-1802
27811 Greenspot Rd
Highland, CA 92346
Phone (909) 443-2584
27811 Greenspot Rd
Ste A
Highland, CA 92346
Phone (909) 443-2584
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
27811 Greenspot Rd
Highland, CA 92346-4361
Mailing address
27811 Greenspot Rd Ste a
Highland, CA 92346-4361
Phone (909) 443-2584
Other names
- Stallant Health & Wellness
Other providers in Highland, CA
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- Sonya Nicole Songer
- Spectrum Behavioral Health Group LLC
- Edward Lewis Spellman
- John Earl Square I
- Starlight Therapy Center Inc
- Starshine Treatment Center, Inc
- Timothy Michael Stein
- Peter Ehren Sterbutzel
- Mark Raymond Stinson
All providers in Highland, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.