NPIMap

Individual provider Active NPI

Melinda Ellen Stack, M.D.

  • Colon & Rectal Surgery Physician
  • Chicago, IL
National Provider Identifier
1215223490
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
036135948 Issued in IL
Practice address
5140 N California Ave Ste 560
Chicago, IL 60625-2577
Phone
(847) 570-1700
Fax
(847) 982-1098
NPI assigned
Jun 25, 2011
Last updated
Oct 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 036135948 IL Primary

Addresses

Primary practice location

5140 N California Ave Ste 560
Chicago, IL 60625-2577

Mailing address

5140 N California Ave Ste 560
Chicago, IL 60625-2577
Phone (847) 570-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190920000349 MN Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 8921301961 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
University of Chicago, Pritzker School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minnesota Oncology Hematology PAGroup PAC ID 6709799752, 131 clinicians
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1580 Beam Ave
Maplewood, MN 55109-1127
Phone (651) 779-7978

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services General Acute Care Hospital Current Accepting new patients
Fairview Express Care Current Accepting new patients
Minnesota Oncology Hematology, PA CurrentSince Oct 1, 2025 Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2025 Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2025 Accepting new patients
Minnesota Oncology Hematology PA CurrentSince Oct 1, 2025 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2024 Accepting new patients
Fairview Specialty Services CurrentSince Jul 1, 2024 Accepting new patients
Healtheast St. John's Hospital General Acute Care Hospital Past Accepting new patients
Minnesota Oncology Hematology, PA PastSince Jan 12, 2020 Accepting new patients
Minnesota Oncology Hematology, PA Past Accepting new patients

Locations

1175 Paysphere Cir
Chicago, IL 60674

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

2945 Hazelwood St
Ste 340
Maplewood, MN 55109
Phone (651) 312-1620

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

310 Smith Ave N
Ste 100
Saint Paul, MN 55102
Phone (651) 251-5500

Organizations & group practices 11

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1308960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1215223490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE STE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252577",
            "telephone_number": "847-570-1700",
            "fax_number": "847-982-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE STE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252577",
            "telephone_number": "847-570-1700",
            "fax_number": "847-982-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "MELINDA",
        "middle_name": "ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-25",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IL",
            "license": "036135948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.