Jonathan Patrick Staidle, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35-126612 Issued in OH

Practice address

4814 Sparks Blvd
Sparks, NV 89436-8219

Phone

(775) 327-0699

Fax

(775) 451-7501

NPI assigned

Apr 18, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA, NV2 enrollments

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 2

Specialty

Dermatology

Education

Northeastern Ohio University College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLC 103 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jstaidle@skincancerderm.emadirect.md

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.

• Mountain West Derm - Blackhart PLLC

  • MOHS-Micrographic Surgery Physician
  • Reno, NV
  • NPI 1740633015

  Mohs-Micrographic Surgery, NV

  Medicare reassignment Care Compare group NPD
• Benedetto Dermatology, LLC

  • MOHS-Micrographic Surgery Physician
  • Philadelphia, PA
  • NPI 1972771129

  Mohs-Micrographic Surgery, PA

  Medicare reassignment NPD
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Spokane Valley, WA
  • NPI 1013557933
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Anchorage, AK
  • NPI 1124670088
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Georgetown, TX
  • NPI 1366018848
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Bend, OR
  • NPI 1447764741
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Ambulatory Surgical Clinic/Center
  • Spokane Valley, WA
  • NPI 1619517539
  Care Compare group
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Boise, ID
  • NPI 1548758501
  Care Compare group
• Skin Cancer and Dermatology Institute

  • MOHS-Micrographic Surgery Physician
  • Carson City, NV
  • NPI 1003905001

  Mohs-Micrographic Surgery

  NPD
• Benedetto Dermatology,LLC

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
  • NPI 1811938863
  NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994

  Dermatology

  NPD
• Mt Grant General Hospital

  • Critical Access Hospital
  • Hawthorne, NV
  • NPI 1801844527
  NPD (past)

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

{
    "created_epoch": "1303084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1982994455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094903",
            "telephone_number": "775-324-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4814 SPARKS BLVD",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894368219",
            "telephone_number": "775-327-0699",
            "fax_number": "775-451-7501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 W Moana Ln",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895094903",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-323-6814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "607 S Maine St",
            "address_purpose": "LOCATION",
            "city": "Fallon",
            "state": "NV",
            "postal_code": "894063801",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-428-1007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAIDLE",
        "first_name": "JONATHAN",
        "middle_name": "PATRICK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-18",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD457066",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35-126612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129749",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Sparks, NV
• Dermatology Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.