NPIMap

Individual provider Active NPI

Vince J Stack, M.D.

  • Family Medicine Physician
  • Salida, CO
National Provider Identifier
1497706071
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46814 Issued in CO
Practice address
530 W 16TH St
Salida, CO 81201-2240
Phone
(719) 539-6112
NPI assigned
May 16, 2006
Last updated
Feb 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46814 CO Primary

Addresses

Primary practice location

530 W 16TH St
Salida, CO 81201-2240

Mailing address

PO Box 2153 Dept 40339
Birmingham, AL 35287-9387
Phone (423) 310-1642

Other identifiers 1

IdentifierTypeStateIssuer
45604771MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20081215000694 CO Practitioner - Family PracticePractitioner - Geriatric Medicine 0042207003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of Utah School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Care Physician Services LLCGroup PAC ID 5395861306, 18 clinicians

Practice addresses (Care Compare)

530 W 16TH St
Salida, CO 81201-2240
Phone (719) 539-6112

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.69 of 100Reported as group
Quality
71.4
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46814COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Life Care Physician Services, LLC CurrentSince Jul 29, 2013 Accepting new patients
Horizon Healthcare Family Medicine Past Accepting new patients
Salida Family Medicine Family Medicine Past Accepting new patients
Colorado Medical Investors, LLC Past Accepting new patients

Locations

240 Craft Dr
Alamosa, CO 81101
Phone (719) 589-3367

905 Harding Ave
Canon City, CO 81212
Phone (719) 275-4106

530 W 16th St
Salida, CO 81201
Phone (303) 751-2000

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Nursing HomeAlamosa, CO, CCN 065234 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 22, 2020
Mar 7, 2025
San Luis Care CenterAlamosa, CO, CCN 065239 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2020
Apr 7, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 8

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1497706071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 40339",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352879387",
            "telephone_number": "423-310-1642",
            "fax_number": "706-270-0487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 W 16TH ST",
            "city": "SALIDA",
            "state": "CO",
            "postal_code": "812012240",
            "telephone_number": "719-539-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "VINCE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "46814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45604771",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salida, CO

Sources for this page

Verify at the official NPI Registry.