NPIMap

Individual provider Active NPI

Paul J Stanish, MD

  • Surgery Physician
  • Hobart, IN
National Provider Identifier
1780689984
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01042582 Issued in IN
Practice address
1400 S Lake Park Ave
Ste 200
Hobart, IN 46342-6791
Phone
(219) 947-6122
Fax
(219) 947-6045
NPI assigned
Jun 15, 2005
Last updated
Apr 25, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01042582 IN Primary

Addresses

Primary practice location

1400 S Lake Park Ave
Ste 200
Hobart, IN 46342-6791

Mailing address

1400 S Lake Park Ave
Ste 200
Hobart, IN 46342-6791
Phone (219) 947-6122

Other identifiers 4

IdentifierTypeStateIssuer
020037867OtherINRR MCR PROVIDER #
100473240BMedicaidIN
000000092005OtherINANTHEM PROVIDER NUMBER
90001166OtherINBC/BS OF ILLINOIS PROV #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050607000384 IN Practitioner - General Surgery 0345283099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Indiana University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

1400 S Lake Park Ave
Suite 200 202
Hobart, IN 46342-6790
Phone (219) 947-6124

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)21
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue11
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01042582INMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc Surgery CurrentSince Jul 1, 2012 Accepting new patients
Merrillville Surgery Center PastSince Feb 27, 2004 Accepting new patients
Surgical Associates of Northwest Indiana, P.C. Surgery PastSince Apr 15, 1997 Accepting new patients
St. Mary Medical Center Inc Past Accepting new patients
Methodist Hospitals Pathology LLC Past Accepting new patients
St Mary Medical Center Inc Past Accepting new patients

Locations

1400 S Lake Park Ave
Ste 200202
Hobart, IN 46342
Phone (219) 947-6122

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

164 Bracken Pkwy
Hobart, IN 46342
Phone (219) 942-1145

8558 Broadway
Merrillville, IN 46410
Phone (219) 392-7084

9239 Broadway
Merrillville, IN 46410
Phone (219) 736-1010

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

Interoperability endpoints

  • Direct secure messaging: pstanish11420@ssdirect.comhs.org

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1780689984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S LAKE PARK AVE",
            "address_2": "STE 200",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426791",
            "telephone_number": "219-947-6122",
            "fax_number": "219-947-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S LAKE PARK AVE",
            "address_2": "STE 200",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426791",
            "telephone_number": "219-947-6122",
            "fax_number": "219-947-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANISH",
        "first_name": "PAUL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01042582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR PROVIDER #",
            "identifier": "020037867",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100473240B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000092005",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF ILLINOIS PROV #",
            "identifier": "90001166",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, IN

Sources for this page

Verify at the official NPI Registry.