JUSTIN R STALEY (DO) – Emergency Medicine Physician, NPI 1164044830

JUSTIN R STALEY (DO) is a healthcare provider. based in Muskegon, Michigan. specializing in EMERGENCY MEDICINE. They hold the professional credentials DO. They hold a License No. 5101026712 (MI). The NPI Number for JUSTIN R STALEY (DO) is 1164044830

Main info

Male
Sole Proprietor
6 Years Of Experience
Accepts Medicare Assignment
Name
JUSTIN R STALEY (DO)
NPI
1164044830
Phone
Not provided
Address
1675 LEAHY ST STE 315A
Enumeration Date
15 May 2020
Last Update Date
24 January 2024

Doctor Profile

Medical School Name
MARIAN UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
6166853900
Graduation Year
2020 (6 years ago)
PAC ID
4183075088
Group Practice PAC ID
3274425905
Professional Enrollment ID
I20240104002536
Address ID
MI493157974BY2373XSWXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience41
Completeness75
Years active:6State licenses:1Digital endpointsOther names

3,158 EMERGENCY MEDICINE in MI

Provider Addresses for JUSTIN R STALEY (DO)

  • 1675 LEAHY ST STE 315A

    MUSKEGON, MI 494425543

    Phone:

    Type: Mailing

  • 1700 CLINTON ST

    MUSKEGON, MI 494425502

    Phone: (231) 726-3511

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240104002536IEmergency MedicineMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 49442)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3274425905View full group profile
NameSpecialtyState
Emergency MedicineMI
Emergency MedicineMI
Physician AssistantMI
Emergency MedicineMI
Nurse PractitionerMI
Emergency MedicineMI
Physician AssistantMI
Physician AssistantMI
Emergency MedicineMI
Physician AssistantMI

Reviews

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Frequently asked questions

Does JUSTIN R STALEY (DO) have a public NPI I can cite?
Public records show JUSTIN R STALEY (DO) under NPI 1164044830.
Should I treat JUSTIN R STALEY (DO) as an active provider?
Patients and plans typically see JUSTIN R STALEY (DO) as active in the national extract.
What services align with JUSTIN R STALEY (DO)'s listing?
JUSTIN R STALEY (DO)'s public classification highlights Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to JUSTIN R STALEY (DO)?
The directory associates JUSTIN R STALEY (DO) with Muskegon, Michigan. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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