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Active NPI 1033108667 Individual Practitioner Male Practitioner

Matthew A Stack , PA-C

Physician Assistant • Ithaca, MI

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Matthew Stack, PA-C is a certified Physician Assistant practicing in Ithaca, MI. With approximately 24 years of clinical experience since completing medical education in 2002, Matthew Stack delivers high-quality medical care to the local community at 121 N PINE RIVER ST.

Matthew Stack maintains professional affiliations with Trauma And Addiction Solutions, Pllc, Genesee Health System and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

121 N Pine River St

Ithaca, MI 488471039

Telephone 9892870662
Associated Practice Facility / Clinic
🏢 Michael Stack Md Pc Facility NPI 1376580175

Medicare Profile & Education

Medical School

Other

Graduation Year

2002

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Ithaca, MI

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
24 Yrs Matches City Avg
City Avg: 24.0 Yrs
State Avg: 12.2 Yrs
Regional Practice Density
3 Specialists

Practicing in Ithaca, MI (7057 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Stack (24 Years) 24 Yrs
Ithaca Specialty Average (24.0 Years) 24.0 Yrs

Medical Specialties & State Licenses

CMS Verified: 2026-02-05
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License MI 5601003961

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Psychologist

NUCC Taxonomy Code: 103T00000X

State License MI 6301007939

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

Definition to come...

Physician Assistant

NUCC Taxonomy Code: 363A00000X

State License AZ 2782

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
762246 (AZ)
Commercial Insurance / Payer ID Railroad
P00140431 (AZ)
Commercial Insurance / Payer ID Bcbsm
0852900260 (MI)
Commercial Insurance / Payer ID Medicaid
50155318 (NM)

Hospital & Practice Group Affiliations

Trauma And Addiction Solutions, Pllc

121 N Pine River St, Ithaca, MI 488471039

Phone: 9898750662

Genesee Health System

420 W 5th Ave, Flint, MI 485032445

Phone: 8102573736

Genesee Health System

1040 W Bristol Rd, Flint, MI 485075516

Phone: 8102573705

Secondary Practice Locations

1040 W Bristol Rd

Flint, MI 485075516

Phone: 8102573705

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Cora Pavlik , FNP

Nurse Practitioner - Family

NPI 1043704133

Family Nurse Practitioner

Elizabeth Hackert-Neff , MA LPC

Counselor - Professional

NPI 1528210366

MALPC

Dr. Michael Stack , MD

Family Medicine

NPI 1932146685

Doctor of Medicine (M.D.)

Aubree Akers , FNP

Nurse Practitioner - Family

NPI 1982321378

Family Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events
📍
Updated Practice Location May 10, 2024

Registered at 121 N PINE RIVER ST, ITHACA, MI 488471039 (Tel: 9892870662)

📍
Updated Business Mailing Address May 10, 2024

Registered at 121 N PINE RIVER ST, ITHACA, MI 488471039 (Tel: 9892870662)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 10, 2024

Psychologist (License #6301007939 in MI)

📍
Updated Practice Location January 29, 2024

Registered at 420 W 5TH AVE, FLINT, MI 485032445 (Tel: 8102573705)

📍
Updated Business Mailing Address January 29, 2024

Registered at 420 W 5TH AVE, FLINT, MI 485032445 (Tel: 8102573705)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 29, 2024

Physician Assistant (License #5601003961 in MI)

NPI Profile Active September 21, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location September 21, 2016

Registered at 330 E WARWICK DR, ALMA, MI 488011014 (Tel: 9896298140)

📍
Updated Business Mailing Address September 21, 2016

Registered at 330 E WARWICK DR, ALMA, MI 488011014 (Tel: 9896298140)

👤
Provider Name / Credentials Updated September 21, 2016

Recorded as MATTHEW STACK, PA C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 21, 2016

Psychologist (License #6301007939 in MI)

🟢
Initial NPI Registration & Enumeration October 17, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1033108667
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 17, 2005
Last Update: February 05, 2026
Sole Proprietor: No

Mailing Address

121 N Pine River St

Ithaca, MI 488471039

Phone: 9892870662

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.