Individual provider Active NPI

Stephen K Pearl, M.D.

  • Family Medicine Physician
  • East Aurora, NY
National Provider Identifier
1740323385
Registry record updated Jan 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
149605 Issued in NY
Practice address
19 Center St
East Aurora, NY 14052-2203
Phone
(716) 652-0012
NPI assigned
Feb 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 149605 NY Primary

Addresses

Primary practice location

19 Center St
East Aurora, NY 14052-2203

Mailing address

19 Center St
East Aurora, NY 14052-2203
Phone (716) 652-0012

Other identifiers 1

IdentifierTypeStateIssuer
P010149605OtherBLUE CHOICE LEGACY#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20070802000269 NY Practitioner - Family Practice 4183715311 Practice locations: Orchard Park, NY

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3045 Southwestern Blvd
Suite 102
Orchard Park, NY 14127-1209

3085 Southwestern Blvd
Suite 202
Orchard Park, NY 14127-1233
Phone (716) 677-4321

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
149605NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John P. Ward Family Medicine Past Accepting new patients

Organizations & group practices 1

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": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232928000000",
    "number": "1740323385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 CENTER ST",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522203",
            "telephone_number": "716-652-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 CENTER ST",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522203",
            "telephone_number": "716-652-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARL",
        "first_name": "STEPHEN",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2009-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "149605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE LEGACY#",
            "identifier": "P010149605",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Aurora, NY

Sources for this page

Verify at the official NPI Registry.