Jonathan Devon Mack, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305215805 Issued in VA

Practice address

9881 Broken Land Pkwy Ste 103
Columbia, MD 21046-3013

Phone

(301) 798-4838

NPI assigned

Sep 10, 2024

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

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Virginia Commonwealth University, School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Duke University Health System, IncGroup PAC ID 2567372345, shared by 22 NPIs, 1,083 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Duke University Health System, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1376574798
  Medicare reassignment NPD
• Duke University Health System, Inc.

  • Certified Registered Nurse Anesthetist
  • Durham, NC
  • NPI 1558392977

  Physical Therapist

  Medicare reassignment NPD
• Duke University Health System, Inc.

  • Parenteral & Enteral Nutrition Supplies (DME)
  • Durham, NC
  • NPI 1427187525
  NPD

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1295561090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 BOULDER LAKE DR APT 1201",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232255570",
            "telephone_number": "757-641-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9881 BROKEN LAND PKWY STE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463013",
            "telephone_number": "301-798-4838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JONATHAN",
        "middle_name": "DEVON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305215805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mollie Mace
• Janet Elizabeth Macfarlane, LCSWC
• Greta Michele Macgill, LCPC, RPT
• Kirthi Machireddy, DO
• Ashley Mack
• Telissa Mackall
• Angelica Lynn Mackey, RN
• Juanita Mackey
• Sheila Samantha Macklin, MD R189959
• Nichole Elizabeth Macko

• Physical Therapist in Columbia, MD
• Providers in Columbia, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.