Richard Lyle Staller, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25525 Issued in CO

Practice address

30940 Stagecoach Blvd
Suite E290
Evergreen, CO 80439-7984

Phone

(303) 674-8153

Fax

(303) 674-8303

NPI assigned

Apr 27, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962469742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30940 STAGECOACH BLVD",
            "address_2": "SUITE E290",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804397984",
            "telephone_number": "303-674-8153",
            "fax_number": "303-674-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30940 STAGECOACH BLVD",
            "address_2": "SUITE E290",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804397984",
            "telephone_number": "303-674-8153",
            "fax_number": "303-674-8303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLER",
        "first_name": "RICHARD",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "25525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01255256",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "38662",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1016326",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spero Behavioral Health LLC
• Beverly Keeler Sprout, DDS
• Jeffrey James Sprout, DDS
• Catherine Spykstra, ATC
• Marie Ann St. Denis, L.AC
• Carolyn Joan Steere, MC
• Dereck Steffe, PT
• Jason C Steinle, D.C.
• Jennifer Stock, LCMT
• Eric Robert Stoltz

• Family Medicine Physician in Evergreen, CO
• Providers in Evergreen, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.