NPIMap

Individual provider Active NPI

Todd Aaron Stack, MMSC

  • Physician Assistant
  • Reno, NV
National Provider Identifier
1578809406
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
572271 Issued in TX
Practice address
1180 W Peckham LN
Reno, NV 89509-5220
Phone
(512) 410-9650
NPI assigned
Dec 20, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 572271 TX Primary

Addresses

Primary practice location

1180 W Peckham LN
Reno, NV 89509-5220

Mailing address

1703 Country Club Drive
Midlad, TX 79701
Phone (512) 410-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC, NV3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140604001068 TX Practitioner - Physician Assistant 5698912590
I20161010001984 NC Practitioner - Physician Assistant 5698912590 Reassigns benefits to 1 organization
I20171009003575 NV Practitioner - Physician Assistant 5698912590 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edwards Bell MD PCGroup PAC ID 3971086158, 7 clinicians

Practice addresses (Care Compare)

2375 E Prater Way
Sparks, NV 89434-9641
Phone (775) 331-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
572271TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Jan 26, 2021 Accepting new patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Jan 26, 2021 Accepting new patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Jan 26, 2021 Accepting new patients

Locations

360 S Lola Ln
Pahrump, NV 89048
Phone (775) 751-7500

6500 Longley Ln
Reno, NV 89511
Phone (775) 331-7000

1511 Oppio Ranch Pkwy
Sparks, NV 89436
Phone (775) 567-5400

Interoperability endpoints

  • Direct secure messaging: todd.stack.1@26476.direct.athenahealth.com

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 6

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": "1355961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1578809406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 COUNTRY CLUB DRIVE",
            "city": "MIDLAD",
            "state": "TX",
            "postal_code": "79701",
            "telephone_number": "512-410-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 W PECKHAM LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095220",
            "telephone_number": "512-410-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "TODD",
        "middle_name": "AARON",
        "name_prefix": "Mr.",
        "credential": "MMSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-20",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "572271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.