Individual provider Active NPI

Diane Hweelan Mak, M.D.

  • Internal Medicine Physician
  • North Las Vegas, NV
National Provider Identifier
1053632844
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21085 Issued in NV
Practice address
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Phone
(702) 791-9000
NPI assigned
Jun 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21085 NV Primary

Addresses

Primary practice location

6900 N Pecos Rd
North Las Vegas, NV 89086-4400

Mailing address

6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Phone (702) 791-9000

Other identifiers 2

IdentifierTypeStateIssuer
1053632844MedicaidNV
21085OtherNVSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20210824001954 NV Practitioner - Internal Medicine 6901031624 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21085NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Holdings Nevada Inc CurrentSince Jan 1, 2022 Accepting new patients
Intermountain Medical Holdings Nevada Inc Family Medicine CurrentSince Jan 1, 2022 Accepting new patients
Healthcare Partners Medical Group Coats LTD Family Medicine Current Accepting new patients
Springfield Clinic LLP Current Accepting new patients

Locations

1025 S 6th St
Springfield, IL 62703

595 W Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 566-5500

2825 Siena Heights Dr
Ste 102
Henderson, NV 89052
Phone (702) 940-1535

6355 S Buffalo Dr
Fl 3
Las Vegas, NV 89113
Phone (702) 479-4881

4880 Wynn Rd
Las Vegas, NV 89103
Phone (702) 382-4554

1397 S Loop Rd
Pahrump, NV 89048
Phone (775) 727-5500

Interoperability endpoints

  • Direct secure messaging: dianeaw@sfc.allscriptsdirect.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1053632844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 N PECOS RD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890864400",
            "telephone_number": "702-791-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 N PECOS RD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890864400",
            "telephone_number": "702-791-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAK",
        "first_name": "DIANE",
        "middle_name": "HWEELAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-16",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "21085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053632844",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "21085",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.