Mary Elaine Stauble, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

21058 Issued in KY

Practice address

401 E Chestnut St
Suite 410
Louisville, KY 40202-5700

Phone

(502) 271-5999

Fax

(502) 271-5994

NPI assigned

Dec 5, 2005

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 identifiers 7

Medicare fee-for-service enrollment

Enrolled in KY

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

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 and National Provider Directory roles.

• University of Louisville Physicians, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1366722316

  Obstetrics & Gynecology

  Medicare reassignment NPD
• University of Louisville Physicians, Inc.

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1316294127
  NPD
• University of Louisville Physicians, Inc.

  • Hematology & Oncology Physician
  • Louisville, KY
  • NPI 1831464940
  NPD

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1952385619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "address_2": "DEPT OB/GYN ATT VICKI MASTERSON",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0329",
            "fax_number": "502-588-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E CHESTNUT ST",
            "address_2": "SUITE 410",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402025700",
            "telephone_number": "502-271-5999",
            "fax_number": "502-271-5994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUBLE",
        "first_name": "MARY",
        "middle_name": "ELAINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "KY",
            "license": "21058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200835760",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64210586",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALTY",
            "identifier": "50015262",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000368677",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT PCP",
            "identifier": "50017317",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000507070",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALTY",
            "identifier": "50006479",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa States
• Victoria Anne Statler, M.D.
• Statom Chiropractic Inc
• Kevin M Statom, D.C.
• Brandon Stauble
• Stephanie Fowler Stauble, LPCC
• Taylor Stauble, MS, RD, LD
• Joshua Stauffer
• Lauren Eileen Stauffer
• Erin Stautberg, MS, CCC-SLP

• Obstetrics & Gynecology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Obstetrics & Gynecology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.