Active NPI
Justin Mack
- Home Health Agency
- Florence, SC
National Provider Identifier
1063041143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 1951 Pisgah Rd Ste 122
Florence, SC 29501-6705 - Phone
- (843) 413-2854
- NPI assigned
- Apr 2, 2020
- Last updated
- Oct 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
1951 Pisgah Rd Ste 122
Florence, SC 29501-6705
Mailing address
1951 Pisgah Rd Ste 122
Florence, SC 29501-6705
Phone (843) 413-2854
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100452463 | Other | SC | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | FirstPalmettoMedicalLLC@yahoo.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Med Atlantic Medical Transport LLC | Current | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Med Atlantic LLC
- Land Ambulance
- Darlington, SC
- NPI 1912709650
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633564800000",
"number": "1063041143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1951 PISGAH RD STE 122",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295016705",
"telephone_number": "843-413-2854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1951 PISGAH RD STE 122",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295016705",
"telephone_number": "843-413-2854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-02",
"last_updated": "2021-10-07",
"certification_date": "2021-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "100452463",
"state": "SC"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "FirstPalmettoMedicalLLC@yahoo.com",
"affiliation": "N",
"endpointDescription": "Email Address",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "111 Farm St",
"city": "Darlington",
"state": "SC",
"country_code": "US",
"postal_code": "295325619",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Florence, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.