Active NPI
Corby Rae Stark, MA PC
- Case Manager/Care Coordinator
- Balsam Lake, WI
National Provider Identifier
1780807149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 119 226
- Practice address
- 100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071 - Phone
- (715) 485-8842
- Fax
- (715) 485-8490
- NPI assigned
- Apr 11, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 119 226 | WI | Primary |
Addresses
Primary practice location
100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071
Mailing address
101 Perry Mound Rd
Balsam Lake, WI 54810-9001
Phone (612) 801-5854
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119 226 | WI | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780807149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 PERRY MOUND RD",
"city": "BALSAM LAKE",
"state": "WI",
"postal_code": "548109001",
"telephone_number": "612-801-5854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 POLK COUNTY PLZ",
"address_2": "SUITE 50",
"city": "BALSAM LAKE",
"state": "WI",
"postal_code": "548109071",
"telephone_number": "715-485-8842",
"fax_number": "715-485-8490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "CORBY",
"middle_name": "RAE",
"credential": "MA PC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "WI",
"license": "119 226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Balsam Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.