Active NPI
Judith Marie Mago, P.A.
- Physician Assistant
- Goodland, KS
National Provider Identifier
1376638569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1501352
- Practice address
- 106 Willow Rd
Goodland, KS 67735-1518 - Phone
- (785) 890-4012
- Fax
- (785) 890-6077
- NPI assigned
- Oct 4, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 872 | CO | |
| Physician Assistant | 363A00000X | 1501352 | KS | Primary |
Addresses
Primary practice location
106 Willow Rd
Goodland, KS 67735-1518
Mailing address
106 Willow Rd
Goodland, KS 67735-1518
Phone (785) 890-4012
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200631060A | Medicaid | KS | |
| 111003004 | Other | KS | BCBS |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 872 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Emergency Physicians LLC | Past | Accepting new patients | |
| Goodland Regional Medical Center | Past | Accepting new patients |
Interoperability endpoints
- judith.mago.1@18308.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Critical Access Hospital Clinic/Center
- Goodland, KS
- NPI 1447392451
-
- Emergency Medicine Physician
- Douglas, WY
- NPI 1306187737
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423094400000",
"number": "1376638569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 WILLOW RD",
"city": "GOODLAND",
"state": "KS",
"postal_code": "677351518",
"telephone_number": "785-890-4012",
"fax_number": "785-890-6077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 WILLOW RD",
"city": "GOODLAND",
"state": "KS",
"postal_code": "677351518",
"telephone_number": "785-890-4012",
"fax_number": "785-890-6077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAGO",
"first_name": "JUDITH",
"middle_name": "MARIE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2015-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "872",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": "1501352",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200631060A",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "111003004",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goodland, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.