NPIMap

Individual provider Active NPI

Mary Joanne Bernadette Stallmeyer, MD, PHD

  • Neuroradiology Physician
  • West Reading, PA
National Provider Identifier
1710979067
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
MD441979 Issued in PA
Practice address
6TH Avenue & Spruce Street
West Reading, PA 19611-1428
Phone
(610) 988-8059
Fax
(610) 988-4242
NPI assigned
Aug 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X D0052263 MD
Neuroradiology Physician 2085N0700X MD441979 PA Primary
Diagnostic Radiology Physician 2085R0202X D0052263 MD
Vascular & Interventional Radiology Physician 2085R0204X D0052263 MD

Addresses

Primary practice location

6TH Avenue & Spruce Street
West Reading, PA 19611-1428

Mailing address

6TH Avenue & Spruce Street
West Reading, PA 19611-1428
Phone (610) 988-8059

Other identifiers 7

IdentifierTypeStateIssuer
1883824MedicaidLA
102564535001MedicaidPA
110800000 2662043MedicaidMD
967707OtherMDAETNA HMO
3811 0020OtherDCCAREFIRST BCBS DC
5235541OtherMDAETNA PPO
KC46SHOtherMDCAREFIRST

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, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
D0052263MDMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Imaging Specialists Diagnostic Radiology Past Accepting new patients
Shipley'S Imaging, LLC Diagnostic Radiology Past Accepting new patients
University Imaging Center, LLC Neuroradiology Past Accepting new patients
David L Bloom PA Diagnostic Radiology Past Accepting new patients
University of Maryland Diagnostic Imaging Specialists P a Neuroradiology Past Accepting new patients
University Imaging Center, LLC Neuroradiology Past Accepting new patients
David L Bloom PA Diagnostic Radiology Past Accepting new patients

Organizations & group practices 7

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": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1710979067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6TH AVENUE & SPRUCE STREET",
            "city": "WEST READING",
            "state": "PA",
            "postal_code": "196111428",
            "telephone_number": "610-988-8059",
            "fax_number": "610-988-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6TH AVENUE & SPRUCE STREET",
            "city": "WEST READING",
            "state": "PA",
            "postal_code": "196111428",
            "telephone_number": "610-988-8059",
            "fax_number": "610-988-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLMEYER",
        "first_name": "MARY",
        "middle_name": "JOANNE BERNADETTE",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-22",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MD",
            "license": "D0052263",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "PA",
            "license": "MD441979",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D0052263",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MD",
            "license": "D0052263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1883824",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102564535001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110800000    2662043",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "967707",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS DC",
            "identifier": "3811 0020",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5235541",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "KC46SH",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Reading, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.