Dennis Dylan Mack

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

65186 Issued in CA

Practice address

1075 E Betteravia Rd Ste 201
Santa Maria, CA 93454-7023

Phone

(805) 621-7714

NPI assigned

Jul 26, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cep America - California

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Jonathan Oheb MD Inc

  • Orthopaedic Surgery Physician
  • Encino, CA
  • NPI 1528546108
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Pomona, CA
  • NPI 1740235258
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1013746320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 E BETTERAVIA RD STE 201",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 E BETTERAVIA RD STE 201",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547023",
            "telephone_number": "805-621-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "DENNIS",
        "middle_name": "DYLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-26",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "65186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristina Macedo
• Julie B Macedo, MSW
• Bonnie Macenka, LVN
• Sarah Machado
• Chandler James Maciel
• Judith Preston Mackey, MA MFT
• Kathy Maclaren
• Jon Walter Maclean, DO
• Robin Bruce Macomber
• Matthew David Madrigal

• Physician Assistant in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.