Active NPI
Renee Staudacher, DO
- Family Medicine Physician
- Indianola, IA
National Provider Identifier
1851309082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02422
- Practice address
- 108 N Jefferson Way
Indianola, IA 50125-2616 - Phone
- (515) 961-8448
- Fax
- (515) 643-9100
- NPI assigned
- Aug 3, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02422 | IA | Primary |
Addresses
Primary practice location
108 N Jefferson Way
Indianola, IA 50125-2616
Mailing address
1055 6TH Ave
Suite 200
Des Moines, IA 50314-2607
Phone (515) 643-8672
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0057687 | Medicaid | IA |
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
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02422 | IA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851309082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 6TH AVE",
"address_2": "SUITE 200",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503142607",
"telephone_number": "515-643-8672",
"fax_number": "515-643-2784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 N JEFFERSON WAY",
"city": "INDIANOLA",
"state": "IA",
"postal_code": "501252616",
"telephone_number": "515-961-8448",
"fax_number": "515-643-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAUDACHER",
"first_name": "RENEE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "02422",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0057687",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianola, IA
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.