Individual provider Active NPI

Jan M Stasiuk, MD

  • Anesthesiology Physician
  • Yakima, WA
National Provider Identifier
1780693259
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00035277 Issued in WA
Practice address
406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713
Phone
(509) 972-1051
Fax
(509) 972-4166
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00035277 WA Primary

Addresses

Primary practice location

406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713

Mailing address

406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713
Phone (509) 972-1051

Other identifiers 1

IdentifierTypeStateIssuer
8211260MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20100727000278 WA Practitioner - Anesthesiology 2466493036 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Memorial Physicians CurrentSince Jan 1, 2017 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Jan 1, 2017 Accepting new patients

Locations

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

406 S 30th Ave
Ste 202
Yakima, WA 98902
Phone (509) 972-1051

Organizations & group practices 2

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1780693259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 S 30TH AVE",
            "address_2": "STE 202",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023713",
            "telephone_number": "509-972-1051",
            "fax_number": "509-972-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 S 30TH AVE",
            "address_2": "STE 202",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023713",
            "telephone_number": "509-972-1051",
            "fax_number": "509-972-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASIUK",
        "first_name": "JAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00035277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8211260",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.