JONATHAN PATRICK STAIDLE M.D. NPI 1982994455

Dermatology in Sparks, NV

NPI 1982994455 Individual Male Years of Experience 11 Dermatology PECOS Enrolled Accepts Medicare Approved Payment

About JONATHAN STAIDLE

Jonathan Staidle is a provider established in Sparks, Nevada and his medical specialization is dermatology with more than 11 years of experience. He graduated from Northeastern Ohio University College Of Medicine in 2011. The NPI number of Jonathan Staidle is 1982994455 and was assigned on April 2011. The practitioner's primary taxonomy code is 207N00000X with license number 35-126612 (OH). The provider is registered as an individual and his NPI record was last updated one year ago.

A dermatologist like Jonathan Patrick Staidle M.d. is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

Jonathan Staidle is enrolled in PECOS and is eligible to order or refer healthcare services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices

Jonathan Staidle is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

NPI

1982994455

Provider Name JONATHAN PATRICK STAIDLE M.D.
Provider Location Address4814 SPARKS BLVD SPARKS, NV 89436
Provider Mailing Address640 W MOANA LN RENO, NV 89509
GenderMale
NPI Entity TypeIndividual
Medical School NameNORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE
Graduation Year2011
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date04-18-2011
Last Update Date01-19-2021


Primary Taxonomy

Taxonomy Code207N00000X
ClassificationDermatology
TypeAllopathic & Osteopathic Physicians
License No.35-126612
License StateOH
Taxonomy DescriptionA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Business Address

JONATHAN PATRICK STAIDLE M.D.
4814 SPARKS BLVD
SPARKS, NV
ZIP 89436
Phone: (775) 327-0699
Fax: (775) 451-7501

Get Directions


Mailing Address

JONATHAN PATRICK STAIDLE M.D.
640 W MOANA LN
RENO, NV
ZIP 89509
Phone: (775) 324-0699



Secondary Locations

607 S Maine St
Fallon, NV 89406
(775) 324-0699
640 W Moana Ln
Reno, NV 89509
(775) 324-0699

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryMD457066PANo

Taxonomy Description: the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0129749MEDICAID (05)OH

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1174620496DR. MICHAEL RILEY HEAPHY JR. M.D.
Individual
Dermatology (Dermatopathology)4814 SPARKS BLVD
SPARKS, NV 89436
(775) 324-0699
1023300977 IRENE HELEN MANNERING M.D.
Individual
Dermatology4814 SPARKS BLVD
SPARKS, NV 89436
(753) 240-6997

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.