Edward P Stack, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301065179 Issued in MI

Practice address

5300 Gateway Ctr
Flint, MI 48507-3930

Phone

(810) 720-9111

Fax

(810) 720-9119

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Loyola University of Chicago, Stritch School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Michigan Vision Institute PLLCGroup PAC ID 1658317748, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.05 of 100Reported as group

Quality

90.74

Improvement activities

40

Cost

75.84

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: estack1152218@direct.hfhs.org

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.

• Michigan Vision Institute PLLC

  • Ophthalmology Physician
  • Flint, MI
  • NPI 1780746081
  Medicare reassignment Care Compare group NPD Authorized official
• Macular Renewal Center PLLC

  • Ophthalmology Physician
  • Flint, MI
  • NPI 1407716574
  Medicare reassignment NPD Authorized official
• SCG Anesthesia, PLLC

  • Anesthesiology Physician
  • Flint, MI
  • NPI 1821866476
  NPD (past) Authorized official
• Surgery Center at Gateway LLC

  • Anesthesiology Physician
  • Flint, MI
  • NPI 1679270144
  NPD (past) Authorized official
• Genesee Care L.L.C.

  • Ambulatory Surgical Clinic/Center
  • Flint, MI
  • NPI 1396832549
  NPD (past)
• Great Lakes Eye Institute

  • Retina Specialist (Ophthalmology) Physician
  • Saginaw, MI
  • NPI 1427090976
  NPD (past)
• Great Lakes Eye Institute

  • Ophthalmology Physician
  • Saginaw, MI
  • NPI 1992985840
  NPD (past)
• Keith a. Kobet, M.D., P.C.

  • Ophthalmology Physician
  • Canton, MI
  • NPI 1750385506
  NPD (past)

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1801899885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 GATEWAY CTR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073930",
            "telephone_number": "810-720-9111",
            "fax_number": "810-720-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 GATEWAY CTR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073930",
            "telephone_number": "810-720-9111",
            "fax_number": "810-720-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "EDWARD",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301065179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "15474",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5100110",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4774225",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "C6993",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6736673005",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "110201",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1802511821",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "4301065179",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE MEDICAID",
            "identifier": "000000010198",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH",
            "identifier": "028341",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4604520",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katharine Nicole St. John, B.A., QMHP
• St. Luke N.E.W. Life Center, Inc.
• Stable Beginnings
• Stable Beginnings Wellness Center
• Tiffany Stachiw
• Samantha Michelle Stack
• Connett Stacker
• Alyson Nicole Staehli
• Staff Unlimited, Inc.
• Michael Thomas Stafford II

• Ophthalmology Physician in Flint, MI
• Providers in Flint, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.