Samuel Stahly

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

DO.4205 Issued in AL

Practice address

802 Bank St NE
Decatur, AL 35601-1612

Phone

(205) 977-9876

Fax

(256) 351-1876

NPI assigned

Mar 29, 2021

Last updated

Sep 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in AL

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

Specialty

Dermatology

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Alabama PCGroup PAC ID 9436211463, 42 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aqua Dermatology of Alabama PC

  dba Sunrise Dermatology

  • MOHS-Micrographic Surgery Physician
  • Vestavia HLS, AL
  • NPI 1477708642

  Dermatology

  Medicare reassignment Care Compare group NPD
• Cutaneous Oncology & Surgery Center, LLC

  dba SmoothRock Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Vestavia HLS, AL
  • NPI 1699139915
  NPD (past)
• Jere H. Weaver

  • Dermatology Physician
  • Decatur, AL
  • NPI 1851573778
  NPD (past)

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1922685494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 BANK ST NE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356011612",
            "telephone_number": "205-977-9876",
            "fax_number": "256-351-1876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 BANK ST NE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356011612",
            "telephone_number": "205-977-9876",
            "fax_number": "256-351-1876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7300 Halcyon Summit Dr",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361173699",
            "country_code": "US",
            "telephone_number": "205-977-9876",
            "fax_number": "256-351-1876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAHLY",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-29",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AL",
            "license": "DO.4205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sportsmed Orthopaedic Specialists, P.C.
• Patricia M. Springer-Gross
• Albert Lester Sprinkle, M.D.
• Benjamin Stanley Stachowiak, ATC
• Sierra Marie Stadnek
• Kimberly B Standridge
• Louanne Stanford, LPTA
• Harry Patrick Stanley, DMD
• Cedric Dewayne Stanton, NCC, LPC
• Star Optometry Al, LLC (InFocus Eyecare)

• Dermatology Physician in Decatur, AL
• Providers in Decatur, AL by specialty
• Dermatology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; 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.