| Sean Stack, MD | |
|
2925 Ryan Dr Se, Salem, OR 97301-9687 | |
| (503) 399-1264 | |
| (503) 371-0777 |
| Full Name | Sean Stack |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 31 Years |
| Location | 2925 Ryan Dr Se, Salem, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962453217 | NPI | - | NPPES |
| 288438 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 20801 (Oregon) | Secondary |
| 2085R0204X | Radiology - Vascular & Interventional Radiology | MD20801 (Oregon) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Salem Hospital | Salem, OR | Hospital |
| Legacy Mount Hood Medical Center | Gresham, OR | Hospital |
| West Valley Hospital | Dallas, OR | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Salem Radiology Consultants Pc | 0446148498 | 28 |
| Pacific Imaging Associates Llc | 3577923499 | 44 |
| Salem Clinic Pc | 7517954514 | 91 |
| Portland Clinic | 8224942867 | 96 |
| Entity Name | Portland Clinic |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558379099 PECOS PAC ID: 8224942867 Enrollment ID: O20031118000101 |
| Entity Name | Salem Radiology Consultants Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649221813 PECOS PAC ID: 0446148498 Enrollment ID: O20040419000602 |
| Entity Name | Salem Clinic Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912935594 PECOS PAC ID: 7517954514 Enrollment ID: O20040430000150 |
| Entity Name | Pacific Imaging Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1265137574 PECOS PAC ID: 3577923499 Enrollment ID: O20230829002458 |
| Mailing Address | Practice Location Address |
|---|---|
| Sean Stack, MD 2925 Ryan Dr Se, Salem, OR 97301-9687 Ph: (503) 399-1264 | Sean Stack, MD 2925 Ryan Dr Se, Salem, OR 97301-9687 Ph: (503) 399-1264 |
Michael Smolin, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 2925 Ryan Dr Se, Salem, OR 97301 Phone: 503-399-1262 Fax: 503-371-0777 | |
Matthew Y Kang, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 875 Oak St Se, Suite 1080, Salem, OR 97301 Phone: 503-561-5294 Fax: 503-561-4789 | |
Gary Jones, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 2925 Ryan Dr Se, Salem, OR 97301 Phone: 503-399-1262 Fax: 503-371-0777 | |
Dr. Jason Cody Hedge, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 2925 Ryan Dr Se, Salem, OR 97301 Phone: 503-399-1262 | |
Dr. Edwin Yen Wang, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 698 12th St Se Ste 145, Salem, OR 97301 Phone: 503-588-2674 Fax: 503-391-1200 | |
Thomas Cullen, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 2925 Ryan Dr Se, Salem, OR 97301 Phone: 503-399-1262 Fax: 503-371-0777 | |
David Harrison, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 2925 Ryan Dr Se, Salem, OR 97301 Phone: 503-399-1262 Fax: 503-371-0777 |