Brian Khristopher Stackhouse, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

376 Seguine Ave
Staten Island, NY 10309-3942

Phone

(718) 226-5976

Fax

(718) 226-2789

NPI assigned

Apr 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Specialty

Psychiatry

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: bstackhouse71538@northwell.direct-ci.com

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1871234989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 SEGUINE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093942",
            "telephone_number": "718-226-5976",
            "fax_number": "718-226-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 SEGUINE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093942",
            "telephone_number": "718-226-5976",
            "fax_number": "718-226-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "BRIAN",
        "middle_name": "KHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Vincent'S Services
• St. Vincent'S Staten Island Surgery Services
• St.Vincent'S Hospital Westchester
• St.Vincent'S Med Ctr Richmond
• Christina Stabile, FNP
• Paul Stadler
• Anastasia Stadnik
• Constance Stafford, LCSW-R
• Alyssa Staiano
• Adrienne Stakofsky, RD

• Student in an Organized Health Care Education/Training Program in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.