Individual provider Active NPI

David Wentworth Mack, MD

  • Anesthesiology Physician
  • Fort Collins, CO
National Provider Identifier
1023512340
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
DR.0070323 Issued in CO
Practice address
3702 Automation Way Ste 103
Fort Collins, CO 80525-5738
Phone
(970) 224-2985
NPI assigned
Mar 21, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X DR.0070323 CO Primary

Addresses

Primary practice location

3702 Automation Way Ste 103
Fort Collins, CO 80525-5738

Mailing address

13001 E 17TH PL
Aurora, CO 80045-2570
Phone (303) 724-1792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230511001657 CO Practitioner - Anesthesiology 9335496041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Colorado School of Medicine, Denver, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Colorado Anesthesia Professionals PLLCGroup PAC ID 6800878760, 155 clinicians

Practice addresses (Care Compare)

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Colorado Anesthesia Professionals PLLC Anesthesiology CurrentSince May 1, 2023 Accepting new patients

Locations

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

3702 Automation Way
Ste 103
Fort Collins, CO 80525
Phone (970) 922-3622

2500 Rocky Mountain Ave
Loveland, CO 80538
Phone (970) 297-6425

Organizations & group practices 1

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1023512340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13001 E 17TH PL",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452570",
            "telephone_number": "303-724-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 AUTOMATION WAY STE 103",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255738",
            "telephone_number": "970-224-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "DAVID",
        "middle_name": "WENTWORTH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0070323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.