Thomas Keane Stetler, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003799 Issued in MI

Practice address

4713 Pine St SW
S Boardman, MI 49680-9761

Phone

(231) 518-0189

Fax

(231) 518-0188

NPI assigned

Aug 29, 2006

Last updated

Apr 21, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

Practice roles

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.

• Boardman Health and Wellness, PLLC

  • Physician Assistant
  • S Boardman, MI
  • NPI 1063453363
  NPD (past) Authorized official
• Boardman Health and Wellness, PLLC

  • Family Medicine Physician
  • South Boardman, MI
  • NPI 1437213667
  Authorized official Same address or phone

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1164531794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "S BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-518-0189",
            "fax_number": "231-518-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "S BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-518-0189",
            "fax_number": "231-518-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STETLER",
        "first_name": "THOMAS",
        "middle_name": "KEANE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boardman Health and Wellness, PLLC

• Physician Assistant in S Boardman, MI
• Providers in S Boardman, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.