Active NPI
Khushal Alam Stanisai, MD
- Gastroenterology Physician
- Redlands, CA
National Provider Identifier
1720019821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- A30298
- Practice address
- 10408 Industrial Circle
Redlands, CA 92374-4548 - Phone
- (909) 796-0363
- Fax
- (909) 796-0762
- NPI assigned
- Jul 6, 2006
- Last updated
- Aug 23, 2011
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | A30298 | CA | Primary |
Addresses
Primary practice location
10408 Industrial Circle
Redlands, CA 92374-4548
Mailing address
10408 Industrial Circle
Redlands, CA 92374-4548
Phone (909) 796-0363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A302982 | Medicaid | CA |
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 |
|---|---|---|---|
| A30298 | CA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314057600000",
"number": "1720019821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10408 INDUSTRIAL CIRCLE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923744548",
"telephone_number": "909-796-0363",
"fax_number": "909-796-0762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10408 INDUSTRIAL CIRCLE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923744548",
"telephone_number": "909-796-0363",
"fax_number": "909-796-0762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANISAI",
"first_name": "KHUSHAL",
"middle_name": "ALAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2011-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CA",
"license": "A30298",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A302982",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.