John Scott Stadalsky, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

24015 Issued in SC

Practice address

105 Springhall Dr
Goose Creek, SC 29445-5370

Phone

(843) 766-6308

Fax

(866) 533-4473

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Scott Stadalsky Professional name

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Musc Affiliate Physicians

  • Psychiatry Physician
  • Charleston, SC
  • NPI 1700465648
  Medicare reassignment NPD
• Musc Affiliate Physicians

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1548849482

  Pediatrics

  NPD (past)
• Plantation Pediatrics, LLC

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1427415298
  NPD (past)
• University Medical Associates

  • Pediatric Allergy/Immunology Physician
  • Charleston, SC
  • NPI 1902323504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1699720250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 SAVAGE RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074726",
            "telephone_number": "843-531-9961",
            "fax_number": "866-533-4473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455370",
            "telephone_number": "843-766-6308",
            "fax_number": "866-533-4473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADALSKY",
        "first_name": "JOHN",
        "middle_name": "SCOTT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "24015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T83086",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SC",
            "identifier": "571020809007",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "571020809042",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SCOTT",
            "last_name": "STADALSKY",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Southcrest ABA Therapy LLC
• Kimberly Space, DPT
• Jay Spateholts
• Miranda Hildred Spurgeon, L.M.T.
• Jason S St Clair, PT
• Star Capital Inc
• Starfish Pediatric ENT, LLC
• Kelsey N Steedly, PA
• Ashley N Steigler
• Sarah B Stevens, PH.D.

• Pediatrics Physician in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.

Verify at the official NPI Registry.