Active NPI
Liza Stanton
- Family Medicine Physician
- O Fallon, MO
National Provider Identifier
1508976523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 110103
- Practice address
- 2630 Highway K
O Fallon, MO 63368-6624 - Phone
- (636) 240-5454
- Fax
- (636) 980-5335
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 110103 | MO | Primary |
Addresses
Primary practice location
2630 Highway K
O Fallon, MO 63368-6624
Mailing address
670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141-8573
Phone (636) 240-5454
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 204963102 | Medicaid | MO |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110103 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- lstanton11418@direct.carenet.org
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337299200000",
"number": "1508976523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR",
"address_2": "STE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "636-240-5454",
"fax_number": "636-980-5335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 HIGHWAY K",
"city": "O FALLON",
"state": "MO",
"postal_code": "633686624",
"telephone_number": "636-240-5454",
"fax_number": "636-980-5335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANTON",
"first_name": "LIZA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2012-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "110103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "204963102",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.