NPIMap

Individual provider Active NPI

Randall Mack, PA-C

  • Physician Assistant
  • Plains, MT
National Provider Identifier
1346356359
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-190 Issued in MT
Practice address
10 Kruger Road
Plains, MT 59859
Phone
(406) 826-4800
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60595202 WA
Physician Assistant 363A00000X MED-PAC-LIC-190 MT Primary

Addresses

Primary practice location

10 Kruger Road
Plains, MT 59859

Mailing address

10 Kruger Road
Plains, MT 59859
Phone (406) 826-4800

Other practice location 1

5901 N Lidgerwood St Ste 126
Spokane, WA 99208-1122
Phone (509) 444-8888

Other identifiers 2

IdentifierTypeStateIssuer
1346356359MedicaidWA
P01684706OtherWARR MEDICARE WVH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, HI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130529000075 MT Practitioner - Physician Assistant 8123266459 Reassigns benefits to 2 organizations
I20160302001956 HI Practitioner - Physician Assistant 8123266459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Plains Hospital CorporationGroup PAC ID 4183691132, 29 clinicians
Providence St Joseph Medical CenterGroup PAC ID 0446230247, shared by 5 NPIs, 52 clinicians

Practice addresses (Care Compare)

10 Kruger Rd
Plains, MT 59859-9262

10 Kruger Rd
Plains, MT 59859-9271
Phone (406) 826-4813

6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377

Hospital & facility affiliations

  • Clark Fork Valley Hospital Hospital, Plains, MT, CCN 271323
  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Logan Health Medical Center Hospital, Kalispell, MT, CCN 270051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
190MTMDSpeech-Language Pathologist
MED-PAC-LIC-190MTMDPhysician Assistant
PA60595202WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Plains Hospital Corporation CurrentSince Jun 26, 2024 Accepting new patients
Plains Hospital Corporation CurrentSince Jun 26, 2024 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rmack308892@wm.providencedirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1346356359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 KRUGER ROAD",
            "city": "PLAINS",
            "state": "MT",
            "postal_code": "59859",
            "telephone_number": "406-826-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 KRUGER ROAD",
            "city": "PLAINS",
            "state": "MT",
            "postal_code": "59859",
            "telephone_number": "406-826-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 N Lidgerwood St Ste 126",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992081122",
            "country_code": "US",
            "telephone_number": "509-444-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "RANDALL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60595202",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346356359",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE WVH",
            "identifier": "P01684706",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plains, MT

Sources for this page

Verify at the official NPI Registry.