Active NPI
Karin F Mack, M.D.
- Psychiatry Physician
- Bennington, VT
National Provider Identifier
1114946035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 042-0009090
- Practice address
- 100 Ledgehill Rd
Bennington, VT 05201-2273 - Phone
- (802) 442-5491
- Fax
- (802) 442-4910
- NPI assigned
- Jul 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 042-0009090 | VT | Primary |
Addresses
Primary practice location
100 Ledgehill Rd
Bennington, VT 05201-2273
Mailing address
PO Box 588
Bennington, VT 05201-0588
Phone (802) 442-5491
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 126-1087 | Other | VT | BLUE CROSS |
| 0VN1125 | Medicaid | VT | |
| 2018556 | Other | CIGNA | |
| 10010392 | Other | CDPHP | |
| 970368 | Other | MVP |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0009090 | VT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Counseling Service of Bennington County, Inc. | Past | 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.
-
- Clinic/Center
- Bennington, VT
- NPI 1427104132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114946035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 588",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052010588",
"telephone_number": "802-442-5491",
"fax_number": "802-442-4910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 LEDGEHILL RD",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052012273",
"telephone_number": "802-442-5491",
"fax_number": "802-442-4910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "KARIN",
"middle_name": "F",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VT",
"license": "042-0009090",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "126-1087",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0VN1125",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2018556",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10010392",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "970368",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bennington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.