Zachary D Mangum, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61160443 Issued in WA

Practice address

884 W Park Ave
Port Townsend, WA 98368-2273

Phone

(360) 385-0321

NPI assigned

Jul 21, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Western Psychological and Counseling Services LLCGroup PAC ID 7719975085, 331 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles (6 of 8)

Locations

Networks

• WA PPO C-SNP
• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

• Direct secure messaging: lifestancehealth.zacharymangum@147765.advancedmd-direct.com
• FHIR API: https://api.qualifacts.org/api/fhir/discoverybh/r4/

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.

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  Medicare reassignment Care Compare group
• Providence Health & Services-Wa

  • Mammography Clinic/Center
  • Everett, WA
  • NPI 1336390442
  Medicare reassignment NPD
• Jefferson Community Counseling Center

  • Community/Behavioral Health Agency
  • Port Townsend, WA
  • NPI 1083701015
  NPD
• Providence Health & Services-Wa

  • Clinic/Center
  • Everett, WA
  • NPI 1972819175
  NPD
• Providence Health & Services-Washington

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
  • NPI 1588294854
  NPD
• Madrona Institute of Washington

  • Addiction (Substance Use Disorder) Counselor
  • Port Townsend, WA
  • NPI 1154410876
  NPD (past)
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178
  NPD (past)

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1053929414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 13TH ST # 4A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "884 W PARK AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682273",
            "telephone_number": "360-385-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "ZACHARY",
        "middle_name": "D",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-21",
        "last_updated": "2021-04-01",
        "certification_date": "2021-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "WA",
            "license": "RN60474418",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61160443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank B Magill Jr., M.D.
• Lisa Marks Mahon
• Bradley Maier
• Roberta Scarlate Gil Maire
• Kelly Marie Malone V
• Christopher P. Manik, MD
• Amy L Mara, PT
• Irene F Marble, RD, CDE
• Ariana Marinelli, LAC
• Vincent Leonard Marquis, CDP

• Psychiatric/Mental Health Nurse Practitioner in Port Townsend, WA
• Providers in Port Townsend, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.