Individual provider Active NPI

Lars Mikael Stensman, M.D.

  • Pediatrics Physician
  • Alpine, CA
National Provider Identifier
1659638062
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A158569 Issued in CA
Practice address
1620 Alpine Blvd Ste 116
Alpine, CA 91901-1103
Phone
(619) 662-4100
NPI assigned
Apr 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MED-PHYS-LIC-41023 MT
Student in an Organized Health Care Education/Training Program 390200000X 0116024330 VA
Pediatrics Physician 208000000X A158569 CA Primary

Addresses

Primary practice location

1620 Alpine Blvd Ste 116
Alpine, CA 91901-1103

Mailing address

1620 Alpine Blvd Ste 116
Alpine, CA 91901-1103
Phone (619) 662-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190711003449 CA Practitioner - Pediatric Medicine 4486956950 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-41023MTMDPediatrics Physician
A158569CAMDPsychiatry Physician
0116024330VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Mar 25, 2021 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Mar 25, 2021 Accepting new patients
Rady Children'S Hospital San Diego Past Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients

Locations

1620 Alpine Blvd
Ste 110
Alpine, CA 91901
Phone (760) 350-9725

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

4050 Beyer Blvd
San Ysidro, CA 92173

120 Town Center Pkwy
Santee, CA 92071
Phone (619) 645-0111

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: lstensman18803@syhealth.direct-ci.com

Organizations & group practices 5

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1659638062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 ALPINE BLVD STE 116",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011103",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 ALPINE BLVD STE 116",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011103",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STENSMAN",
        "first_name": "LARS",
        "middle_name": "MIKAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "MED-PHYS-LIC-41023",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116024330",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A158569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpine, CA

Sources for this page

Verify at the official NPI Registry.