NPIMap

Individual provider Active NPI

Daniel Stachelski, M.D.

  • Family Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1992797898
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301054741 Issued in MI
Practice address
22646 E 9 Mile Rd
Suite a
St Clair Shores, MI 48080-1951
Phone
(586) 498-4800
Fax
(586) 498-4830
NPI assigned
Aug 17, 2005
Last updated
Oct 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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 4301054741 MI Primary

Addresses

Primary practice location

22646 E 9 Mile Rd
Suite a
St Clair Shores, MI 48080-1951

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other identifiers 1

IdentifierTypeStateIssuer
4154293MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dstachelski22233@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20080121000113 MI Practitioner - Family Practice 3476454349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 436-2898

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Nov 1, 2017 Accepting new patients
Oakwood Ambulatory, LLC CurrentSince Nov 1, 2017 Accepting new patients
William Beaumont Hospital Current Accepting new patients
William Beaumont Hospital CurrentSince Oct 1, 2007 Accepting new patients
William Beaumont Hospital CurrentSince Oct 1, 2007 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

468 Cadieux Rd
Grosse Pointe Woods, MI 48230
Phone (313) 343-1000

3601 W 13 Mile Rd
Royal Oak, MI 48073

26001 Jefferson Ave
Saint Clair Shores, MI 48081
Phone (586) 779-7000

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

22646 E 9 Mile Rd
St Clr Shores, MI 48080
Phone (586) 498-4800

22646 E 9 Mile Rd
Ste A
St Clr Shores, MI 48080
Phone (586) 498-4800

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, 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": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1992797898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22646 E 9 MILE RD",
            "address_2": "SUITE A",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801951",
            "telephone_number": "586-498-4800",
            "fax_number": "586-498-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACHELSKI",
        "first_name": "DANIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301054741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4154293",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dstachelski22233@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "22646 E 9 Mile Rd",
            "address_2": "Suite A",
            "city": "St Clair Shores",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480801951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.