Individual provider Active NPI

Paula B Slack, N.P.

  • Nurse Practitioner
  • Ann Arbor, MI
National Provider Identifier
1174858914
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704196109 Issued in MI
Practice address
4260 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone
(734) 764-6831
NPI assigned
Oct 13, 2009
Last updated
Oct 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X COA11004 OH
Nurse Practitioner 363L00000X 4704196109 MI Primary

Addresses

Primary practice location

4260 Plymouth Rd
Ann Arbor, MI 48109-2700

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other practice location 1

1246 Ashland Ave
Suite 202
Zanesville, OH 43701-2861
Phone (740) 455-4925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170612003029 MI Practitioner - Nurse Practitioner 5294873717 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4000

4260 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 647-5650

4270 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 232-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA11004OHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Nurse Practitioner CurrentSince Apr 12, 2022 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Regents of the University of Michigan CurrentSince Apr 12, 2022 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. Primary Care Current Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

380 Parkland Plz
Ann Arbor, MI 48103
Phone (734) 615-3217

4260 Plymouth Rd
Ann Arbor, MI 48109
Phone (734) 647-5715

8001 Challis Rd
Brighton, MI 48116
Phone (810) 227-9510

N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1174858914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 PLYMOUTH RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481092700",
            "telephone_number": "734-764-6831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1246 Ashland Ave",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Zanesville",
            "state": "OH",
            "postal_code": "437012861",
            "country_code": "US",
            "telephone_number": "740-455-4925",
            "fax_number": "740-450-6250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLACK",
        "first_name": "PAULA",
        "middle_name": "B",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-13",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "COA11004",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704196109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.