Active NPI
Stewart Quisling, M.D.
- Child & Adolescent Psychiatry Physician
- Modesto, CA
National Provider Identifier
1609987510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- C323000
- Practice address
- 3340 Tully Rd
D-2
Modesto, CA 95350-0838 - Phone
- (209) 523-5195
- Fax
- (209) 523-5197
- NPI assigned
- Aug 31, 2006
- 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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | C323000 | CA | Primary |
Addresses
Primary practice location
3340 Tully Rd
D-2
Modesto, CA 95350-0838
Mailing address
220 Standiford Ave
Suite F
Modesto, CA 95350-1159
Phone (209) 579-5628
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 770388035 | Other | CA | BLUE SHIELD |
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 |
|---|---|---|---|
| C323000 | CA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267660800000",
"number": "1609987510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 STANDIFORD AVE",
"address_2": "SUITE F",
"city": "MODESTO",
"state": "CA",
"postal_code": "953501159",
"telephone_number": "209-579-5628",
"fax_number": "209-579-5637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 TULLY RD",
"address_2": "D-2",
"city": "MODESTO",
"state": "CA",
"postal_code": "953500838",
"telephone_number": "209-523-5195",
"fax_number": "209-523-5197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUISLING",
"first_name": "STEWART",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2010-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "C323000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "770388035",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.