Active NPI
Klint Howard Stander, MD
- Family Medicine Physician
- Emmett, ID
National Provider Identifier
1629188644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M9508
- Practice address
- 1202 E Locast St
Walter Knox Memorial Hospital
Emmett, ID 83617 - Phone
- (208) 365-3561
- Fax
- (208) 365-4176
- NPI assigned
- Aug 30, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M9508 | ID | Primary |
Addresses
Primary practice location
1202 E Locast St
Walter Knox Memorial Hospital
Emmett, ID 83617
Mailing address
1837 N Substation Rd
Emmett, ID 83617
Phone (208) 365-7727
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HPAB4 | Other | ID | BLUE CROSS IDAHO |
| 000010154123 | Other | ID | REGENCE BLUE SHIELD IDAHO |
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 |
|---|---|---|---|
| M9508 | ID | MD | Family Medicine Physician |
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": "1183852800000",
"number": "1629188644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1837 N SUBSTATION RD",
"city": "EMMETT",
"state": "ID",
"postal_code": "83617",
"telephone_number": "208-365-7727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 E LOCAST ST",
"address_2": "WALTER KNOX MEMORIAL HOSPITAL",
"city": "EMMETT",
"state": "ID",
"postal_code": "83617",
"telephone_number": "208-365-3561",
"fax_number": "208-365-4176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANDER",
"first_name": "KLINT",
"middle_name": "HOWARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M9508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS IDAHO",
"identifier": "HPAB4",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD IDAHO",
"identifier": "000010154123",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Emmett, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.