Individual provider Active NPI

Staci Studer

  • Physical Therapist
  • Virginia Beach, VA
National Provider Identifier
1992828487
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305202704 Issued in VA
Practice address
4560 South Blvd
Suite 310
Virginia Beach, VA 23452-1160
Phone
(757) 490-3223
NPI assigned
Apr 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305202704 VA Primary

Addresses

Primary practice location

4560 South Blvd
Suite 310
Virginia Beach, VA 23452-1160

Mailing address

3205 Jade CT
#302
Virginia Beach, VA 23451-1171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101111000696 HI Practitioner - Physical Therapist in Private Practice 1254526692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Club Rehab, Inc.Group PAC ID 0749193977, 11 clinicians

Practice addresses (Care Compare)

75 -5699 Kopiko St
Kailua Kona, HI 96740-3651
Phone (808) 329-7744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305202704VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Club Rehab, Inc. Physical Therapist CurrentSince Jul 26, 2010 Accepting new patients

Locations

75-5699 Kopiko St
Kailua Kona, HI 96740
Phone (808) 329-7744

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992828487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 JADE CT",
            "address_2": "#302",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234511171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SOUTH BLVD",
            "address_2": "SUITE 310",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234521160",
            "telephone_number": "757-490-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUDER",
        "first_name": "STACI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305202704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.