Jonathan Eberhard Mack, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

50942 Issued in WI

Practice address

185 Queen City Ave
Elliot Orthopaedic Surgery Specialists
Manchester, NH 03101-7100

Phone

(603) 625-1655

Fax

(603) 626-4686

NPI assigned

Oct 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Albert Einstein College of Medicine of Yeshiva University, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vna Home Health and Hospice Services, Inc Home health agency, Manchester, NH, CCN 307003
• Elliot Hospital Hospital, Manchester, NH, CCN 300012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Elliot Professional Services

  • Internal Medicine Physician
  • Manchester, NH
  • NPI 1285627935
  Medicare reassignment Care Compare group NPD
• Elliot Hospital of the City of Manchester

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1902996028
  NPD (past)

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

• Elliot Hospital of the City of Manchester

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1902996028
  Care Compare affiliation
• Vna Home Health & Hospice Services, Inc.

  • Home Health Agency
  • Manchester, NH
  • NPI 1548312705
  Care Compare affiliation

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302652800000",
    "number": "1275522625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "address_2": "ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017100",
            "telephone_number": "603-625-1655",
            "fax_number": "603-626-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "address_2": "ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017100",
            "telephone_number": "603-625-1655",
            "fax_number": "603-626-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JONATHAN",
        "middle_name": "EBERHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2011-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "AZ",
            "license": "33787",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WI",
            "license": "50942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34952800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Machione, PT, DPT
• Laverne V. Macinnis, LCMHC
• Jordan Macintosh, BA
• Barbara B Mack
• Denise E Mack
• Alison Mackay, LICSW
• Molly R Mackey, APRN
• Jake Mackie-Morrissey
• Ashley Mackin
• Jenna Kathryn Mackinnon

• Sports Medicine (Orthopaedic Surgery) Physician in Manchester, NH
• Providers in Manchester, NH by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; 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.