Active NPI
David S Macnally, PA C
- Medical Physician Assistant
- The Dalles, OR
National Provider Identifier
1093753592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10003246
- Practice address
- 1620 E 12TH St
The Dalles, OR 97058 - Phone
- (541) 296-9151
- Fax
- (541) 296-4710
- NPI assigned
- Jun 4, 2006
- Last updated
- Jun 25, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10003246 | WA | Primary |
Addresses
Primary practice location
1620 E 12TH St
The Dalles, OR 97058
Mailing address
PO Box 1520
The Dalles, OR 97058
Phone (541) 296-9151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218112 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10003246 | WA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1093753592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1520",
"city": "THE DALLES",
"state": "OR",
"postal_code": "97058",
"telephone_number": "541-296-9151",
"fax_number": "541-296-4710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 E 12TH ST",
"city": "THE DALLES",
"state": "OR",
"postal_code": "97058",
"telephone_number": "541-296-9151",
"fax_number": "541-296-4710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACNALLY",
"first_name": "DAVID",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-04",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10003246",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218112",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in The Dalles, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.