Active NPI
Ronald A. Mack, D.O.
- Pediatrics Physician
- Fort Eustis, VA
National Provider Identifier
1447211164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- OS010189L
- Practice address
- 576 Jefferson Ave
Fort Eustis, VA 23604-1373 - Phone
- (757) 314-7727
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OS010189L | PA | Primary |
Addresses
Primary practice location
576 Jefferson Ave
Fort Eustis, VA 23604-1373
Mailing address
576 Jefferson Ave
Fort Eustis, VA 23604-1373
Phone (757) 314-7727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Other, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
190 NE 199TH St
Suite 201
Miami, FL 33179-2927
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Past | Accepting new patients | |
| Geisinger Clinic | Pediatrics | Past | Accepting new patients |
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.
-
- Primary Care Clinic/Center
- Miami, FL
- NPI 1801349121
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1447211164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "576 JEFFERSON AVE",
"city": "FORT EUSTIS",
"state": "VA",
"postal_code": "236041373",
"telephone_number": "757-314-7727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "576 JEFFERSON AVE",
"city": "FORT EUSTIS",
"state": "VA",
"postal_code": "236041373",
"telephone_number": "757-314-7727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "RONALD",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "OS010189L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Eustis, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.