Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ian Stack, PA

Individual provider Medical Physician Assistant · NPI 1154590529

Ian Stack, PA is a Physician Assistant in Pinehurst, North Carolina. Qualified in 2002, 24 years ago. Practices with Jefferson Davis Emergency Group LLC, an 18-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
24
Licensed in
NC
In the registry since
2008
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

35 Memorial Dr
Pinehurst, NC 28374-8708
Phone: (910) 715-7856
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 103480 (NC)

Record details

NPI number1154590529
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 29, 2008
Last updated in NPPESFebruary 29, 2008
Mailing address126 James Creek Rd, Southern Pines, NC 28387-6819

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Jefferson Davis Emergency Group Llc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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