Jennifer Ann Stangle, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

Q5285 Issued in TX

Practice address

221 3Rd St W BLDG 359TH
Jbsa Randolph, TX 78150-4800

Phone

(210) 652-8544

NPI assigned

Mar 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Stangle Derousse Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1952360984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-8544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 359TH",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-8544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANGLE",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q5285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DEROUSSE",
            "middle_name": "STANGLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Ann Ryan-Philpott, MD
• Gabrielle Schlain, MD
• Stephanie Marie Smith, LCSW
• Lashika Deshaun Sneed, M.D.
• Pandu Ranga Sridhar, MD
• Kevin Stuessy
• Voncile Deann Stutts, RN
• Alexandra Loan Huynh Tran, O.D.
• Robert Paul Vanhoy, DO
• Kasey Carl Welch, D.O.

• Pediatrics Physician in Jbsa Randolph, TX
• Providers in Jbsa Randolph, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.