NPIMap

Individual provider Active NPI

Marie Monique McCormack, MD

  • Family Medicine Physician
  • Reno, NV
National Provider Identifier
1033178637
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9936 Issued in NV
Practice address
5575 Kietzke LN
Reno, NV 89511-2290
Phone
(775) 851-1505
Fax
(775) 851-1583
NPI assigned
Mar 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9936 NV Primary

Addresses

Primary practice location

5575 Kietzke LN
Reno, NV 89511-2290

Mailing address

1155 Mill St # McM14
Reno, NV 89502-1576
Phone (775) 982-5262

Other practice location 1

13945 S Virginia St Ste 632
Reno, NV 89511-8930
Phone (775) 982-5000

Other identifiers 1

IdentifierTypeStateIssuer
11041134OtherCAQH

Other names 1

  • Marie M Forred Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060504000798 NV Practitioner - Family Practice 5496765471 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nevada School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians

Practice addresses (Care Compare)

10101 Double R Blvd
Reno, NV 89521-5931
Phone (775) 982-7878

1343 Newlands Dr W
Fernley, NV 89408-8926
Phone (775) 982-5000

6570 S McCarran Blvd
Reno, NV 89509-6112
Phone (775) 982-8256

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.15 of 100Reported as group
Quality
78.17
Promoting interoperability
100
Improvement activities
40
Cost
75.68

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
79.09
Promoting interoperability
100
Improvement activities
40
Cost
71.43

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC CurrentSince Jun 28, 2021 Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Central Washington Health Services Association Past Accepting new patients
Community Care Services LLC Past Accepting new patients
Renown Regional Medical Center Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients
Community Care Services LLC Family Medicine Past Accepting new patients

Locations

560 E Williams Ave
Fallon, NV 89406
Phone (775) 428-2022

1343 Newlands Dr W
Fernley, NV 89408
Phone (775) 575-3600

1155 Mill St
#14
Reno, NV 89502

6570 S McCarran Blvd
Reno, NV 89509
Phone (775) 788-5242

21 Locust St
Reno, NV 89502
Phone (775) 982-5270

75 Pringle Way
Ste 601
Reno, NV 89502
Phone (775) 326-8380

850 Harvard Way
Reno, NV 89502

Interoperability endpoints

  • Direct secure messaging: mmccormack8357@direct.renown.org

Organizations & group practices 11

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 5

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": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1033178637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MILL ST # MCM14",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 KIETZKE LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112290",
            "telephone_number": "775-851-1505",
            "fax_number": "775-851-1583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13945 S Virginia St Ste 632",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895118930",
            "country_code": "US",
            "telephone_number": "775-982-5000",
            "fax_number": "775-982-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "MARIE",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "9936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11041134",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "FORRED",
            "middle_name": "M",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.