Individual provider Active NPI

Jan K Stottlemyer, PA

  • Physician Assistant
  • Corte Madera, CA
National Provider Identifier
1922052539
Registry record updated Jan 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
58964 Issued in CA
Practice address
101 Casa Buena Dr
Corte Madera, CA 94925-1762
Phone
(561) 635-0956
NPI assigned
May 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA3632 FL
Physician Assistant 363A00000X 58964 CA Primary

Addresses

Primary practice location

101 Casa Buena Dr
Corte Madera, CA 94925-1762

Mailing address

1509 Dutch LN
Penngrove, CA 94951-9717
Phone (561) 635-0956

Other practice location 1

2440 S Federal Hwy
Suite 400A
Stuart, FL 34994-4500
Phone (561) 635-0956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040510001267 FL Practitioner - Physician Assistant 8527057033 Reassigns benefits to 1 organization
I20240306004292 CA Practitioner - Physician Assistant 8527057033 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Florida College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brett V Curtis MD a Professional Corporation IncGroup PAC ID 6507194297, 7 clinicians

Practice addresses (Care Compare)

411 3Rd St
San Rafael, CA 94901-3548
Phone (415) 924-4525

7428 Redwood Blvd
Suite 100
Novato, CA 94945-2419
Phone (415) 895-5216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Emergency Services Past Accepting new patients
Housecalls Express Inc Medical Past Accepting new patients

Organizations & group practices 5

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704585600000",
    "number": "1922052539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 DUTCH LN",
            "city": "PENNGROVE",
            "state": "CA",
            "postal_code": "949519717",
            "telephone_number": "561-635-0956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CASA BUENA DR",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251762",
            "telephone_number": "561-635-0956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2440 S Federal Hwy",
            "address_2": "Suite 400A",
            "address_purpose": "LOCATION",
            "city": "Stuart",
            "state": "FL",
            "postal_code": "349944500",
            "country_code": "US",
            "telephone_number": "561-635-0956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOTTLEMYER",
        "first_name": "JAN",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-01-07",
        "certification_date": "2024-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA3632",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corte Madera, CA

Sources for this page

Verify at the official NPI Registry.