Active NPI
Bennett Robert Stadler
- Physician Assistant
- Jber, AK
National Provider Identifier
1679056659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 673 MDG 5955 Zeamer Avenue
Jber, AK 99506 - Phone
- (907) 580-1571
- NPI assigned
- Sep 14, 2018
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
673 MDG 5955 Zeamer Avenue
Jber, AK 99506
Mailing address
5955 Zeamer Ave
673 MDG / JB Elmendorf-Richardson Usaf
Anchorage, AK 99506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200710002813 | AK | Order and Referring Only - Physician Assistant | 0749603660 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740441600000",
"number": "1679056659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5955 ZEAMER AVE",
"address_2": "673 MDG / JB ELMENDORF-RICHARDSON USAF",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "99506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "673 MDG 5955 ZEAMER AVENUE",
"city": "JBER",
"state": "AK",
"postal_code": "99506",
"telephone_number": "907-580-1571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STADLER",
"first_name": "BENNETT",
"middle_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-14",
"last_updated": "2025-02-25",
"certification_date": "2025-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jber, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.