Active NPI
Dale M Stark, MD
- Pediatrics Physician
- Elk Grove, CA
National Provider Identifier
1598862526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A41495
- Practice address
- 9281 Office Park Cir
#120
Elk Grove, CA 95758-8068 - Phone
- (916) 691-5999
- Fax
- (916) 691-6717
- NPI assigned
- Sep 20, 2006
- Last updated
- May 12, 2015
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A41495 | CA | Primary |
Addresses
Primary practice location
9281 Office Park Cir
#120
Elk Grove, CA 95758-8068
Mailing address
10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A414950 | Medicaid | CA |
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 |
|---|---|---|---|
| A41495 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Valley Medical Foundation | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Durable Medical Equipment & Medical Supplies
- Sacramento, CA
- NPI 1295800787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431388800000",
"number": "1598862526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10470 OLD PLACERVILLE RD",
"address_2": "SUITE 100",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958272539",
"telephone_number": "800-470-0071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9281 OFFICE PARK CIR",
"address_2": "#120",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957588068",
"telephone_number": "916-691-5999",
"fax_number": "916-691-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "DALE",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2015-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A41495",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A414950",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.