Vickie Stark, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

11270 Issued in NV

Practice address

2845 Siena Heights Dr
Henderson, NV 89052-4153

Phone

(702) 877-5099

NPI assigned

Sep 13, 2006

Last updated

Mar 25, 2024By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in NV

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vstark119511@westdirect.optum.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optum Medical Group II Rhodes P C

  dba Southwest Medical

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1790329407
  Medicare reassignment NPD
• Southwest Medical Associates, Inc

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1659346005
  Medicare reassignment NPD
• Optum Medical Group Rhodes P C

  dba Optumcare Anesthesia

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1770556037
  NPD
• Dignity Health

  dba St. Rose Dominican Hospital, Siena Campus

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1770626426
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1740385913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "702-877-5306",
            "fax_number": "702-252-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 SIENA HEIGHTS DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524153",
            "telephone_number": "702-877-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "VICKIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "11270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740385913",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505591",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Star Brite Dental, Hai Q. Xa D.M.D. Prof. Corp. (Star Brite Dental)
• Star Med Consulting LLC (S William Pierce MD)
• Star Primary Care, L.L.C. (Star Family Care)
• Gregory Stark
• June Stark
• Starling Oncology Ca, a Professional Corporation (Starling Oncology)
• Julia Starman
• State of Nevada (Southern Nevada Adult Mental Health Pharmacy)
• Sandra Staudenmaier
• Jona Stead, AGNP, APN-BC

• Pediatrics Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• Pediatrics Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; 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.