NPIMap

Organization Active NPI

Michael Stack MD PC

Doing business as Family Medical Care

  • Rural Health Clinic/Center
  • Ithaca, MI
National Provider Identifier
1376580175
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4301064712 Issued in MI
Legal business name
MICHAEL STACK MD PC
Doing business as
Family Medical Care
Practice address
121 N Pine River St
Ithaca, MI 48847-1039
Phone
(989) 875-5111
Fax
(989) 875-5023
NPI assigned
Jun 1, 2006
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

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

Authorized official

Name
Dr. Michael Andrew Stack, MDNPI 1932146685
Title
Owner
Phone
(989) 875-5111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4301064712 MI Primary
Family Nurse Practitioner 363LF0000X MI
Family Medicine Physician 207Q00000X MI

Addresses

Primary practice location

121 N Pine River St
Ithaca, MI 48847-1039

Mailing address

121 N Pine River St
Ithaca, MI 48847-1039
Phone (989) 875-5111

Other identifiers 1

IdentifierTypeStateIssuer
0B91071OtherMIBCBSM

Other names 1

  • Family Medical Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1376580175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "488471039",
            "telephone_number": "989-875-5111",
            "fax_number": "989-875-5023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "488471039",
            "telephone_number": "989-875-5111",
            "fax_number": "989-875-5023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL STACK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-875-5111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": "4301064712",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0B91071",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ithaca, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.