Kelsey Marie Stack, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

262832 Issued in NY

Practice address

750 E Adams St
Syracuse, NY 13210-2342

Phone

(315) 464-5136

NPI assigned

May 19, 2009

Sex

Female

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 NY

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

Specialty

Emergency Medicine

Education

New York College of Osteo Medicine of New York Institute of Technology, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Upstate Emergency Medicine, IncGroup PAC ID 2466443494, 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241

Merit-based Incentive Payment System (MIPS)

Final score

95.37 of 100Reported as group

Quality

86.1

Promoting interoperability

100

Improvement activities

40

Cost

70.12

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kstack2765@direct.upstate.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Upstate Emergency Medicine, Inc

  • Emergency Medicine Physician
  • Syracuse, NY
  • NPI 1275589582
  Medicare reassignment Care Compare group NPD
• Emergency Medicine Physicians of Cortland County, PLLC

  • Emergency Medicine Physician
  • Cortland, NY
  • NPI 1609816024
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Suny Health Science Center at Syracuse

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1578554630
  Care Compare affiliation

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1033344049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 LAFAYETTE RD",
            "city": "LA FAYETTE",
            "state": "NY",
            "postal_code": "130849529",
            "telephone_number": "315-677-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-19",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "262832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03428026",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven M St.Onge, PHARMD
• Holly Stacey, MD
• Steven Charles Stacey, D.D.S.
• Mary E Stachelek
• Elizabeth S Stack, RN
• Marissa Stack
• Jasmine Stackhouse, MSOTR/L
• Paige S. Stadniuk
• Todd M Stady, OTR/L
• Alexandria Stafford, PMHNP-BC

• Emergency Medicine Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; 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.