Cullen Anthony Mack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA180563 Issued in OR

Practice address

870 S Front St Ste 200
Central Point, OR 97502-2779

Phone

(541) 732-8120

NPI assigned

Nov 23, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cmack965267@oc.providencedirect.org

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.

• Providence Health & Services Oregon

  • Family Medicine Physician
  • Medford, OR
  • NPI 1568547503

  OR

  Medicare reassignment Care Compare group
• Providence Health & Services - Oregon

  • Hospitalist Physician
  • Medford, OR
  • NPI 1154675411
  NPD
• Providence Health & Services - Oregon

  • Clinic/Center
  • Phoenix, OR
  • NPI 1992882500
  NPD
• Providence Health & Services - Oregon

  • Internal Medicine Physician
  • Central Point, OR
  • NPI 1609951649
  NPD (past)
• Valley Immediate Care, LLC

  • Non-Pharmacy Dispensing Site
  • Medford, OR
  • NPI 1225544695
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1689755670

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services Oregon 166 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Medford Medical Center Hospital, Medford, OR, CCN 380075

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1104369099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180",
            "telephone_number": "541-732-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 S FRONT ST STE 200",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975022779",
            "telephone_number": "541-732-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "CULLEN",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-23",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA180563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500723840",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Kelley Lucas, FNP-C
• Wiley Everett Lumsden, RPH
• Becky Kay Lunsford
• Martin James Lythgoe, CADC III, NCAC II
• Christina Marie Mabry, O.D.
• Darian Madison
• Rebecca Magee, PHARMD
• Morris Maizels, MD
• Allison Hailey Marek
• Mark Bradshaw MD PC

• All providers in Central Point, OR
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.