Individual provider Active NPI

Jacob Stahl, CRNA

  • Certified Registered Nurse Anesthetist
  • Traverse City, MI
National Provider Identifier
1801209200
Registry record updated Apr 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704272613 Issued in MI
Practice address
4100 Park Forest Dr
Suite 201
Traverse City, MI 49684-7331
Phone
(231) 935-5770
Fax
(231) 935-0747
NPI assigned
Jun 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704272613 MI Primary

Addresses

Primary practice location

4100 Park Forest Dr
Suite 201
Traverse City, MI 49684-7331

Mailing address

4100 Park Forest Dr
Suite 201
Traverse City, MI 49684-7331
Phone (231) 935-5770

Other identifiers 1

IdentifierTypeStateIssuer
1801209200MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141103000531 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 1456572635 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Wayne State University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

1200 6TH St
Traverse City, MI 49684-2369
Phone (231) 935-5800

4100 Park Forest Dr
Traverse City, MI 49684-7331
Phone (231) 392-8900

Hospital & facility affiliations

  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Surgery Center PLC CurrentSince Feb 25, 2026 Accepting new patients
Munson Medical Group CurrentSince Sep 16, 2022 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2025 Accepting new patients
Munson Medical Group Nurse Anesthetist, Certified Registered CurrentSince Sep 16, 2022 Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

1200 Sixth St
Ste 200
Traverse City, MI 49684

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

4100 Park Forest Dr
Ste 201
Traverse City, MI 49684
Phone (231) 935-5770

1105 Sixth St
Ste 103
Traverse City, MI 49684
Phone (231) 935-6455

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

5080 N Royal Dr
Traverse City, MI 49684
Phone (231) 929-2500

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

4100 Park Forest Dr
Ste 210
Traverse City, MI 49684
Phone (231) 935-5770

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429056000000",
    "number": "1801209200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 201",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 201",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "JACOB",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-04",
        "last_updated": "2015-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704272613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801209200",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.