Individual provider Active NPI

James Edwin Stoll Jr., MD

  • Orthopaedic Surgery Physician
  • Glendale, WI
National Provider Identifier
1790713527
Registry record updated Feb 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
26052 Issued in WI
Practice address
525 W River Woods Pkwy Ste 240
Glendale, WI 53212-1010
Phone
(414) 807-6128
Fax
(339) 207-0541
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 26052 WI Primary

Addresses

Primary practice location

525 W River Woods Pkwy Ste 240
Glendale, WI 53212-1010

Mailing address

611 E Lake Hill CT
Milwaukee, WI 53217-4351
Phone (414) 962-4645

Other identifiers 2

IdentifierTypeStateIssuer
30590700MedicaidWI
P00707813OtherWIRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20041117000888 WI Practitioner - Orthopedic SurgeryPractitioner - General Practice 1658335773

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Spine Center SC CurrentSince Mar 1, 2021 Accepting new patients
Midwest Spinal Center Past Accepting new patients

Locations

525 W River Woods Pkwy
Ste 240
Glendale, WI 53212
Phone (414) 807-6128

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23541/brand/1/csg/1/fhir/r4

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614384000000",
    "number": "1790713527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E LAKE HILL CT",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174351",
            "telephone_number": "414-962-4645",
            "fax_number": "339-207-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 W RIVER WOODS PKWY STE 240",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121010",
            "telephone_number": "414-807-6128",
            "fax_number": "339-207-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLL",
        "first_name": "JAMES",
        "middle_name": "EDWIN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "26052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30590700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00707813",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

Verify at the official NPI Registry.