NPIMap

Individual provider Active NPI

Kristin L Mack, DO

  • Family Medicine Physician
  • Malone, NY
National Provider Identifier
1447539507
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
272786 Issued in NY
Practice address
125 Finney Blvd
Malone, NY 12953-1067
Phone
(518) 481-8160
Fax
(518) 481-8161
NPI assigned
Aug 8, 2011
Last updated
Mar 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 272786 NY Primary

Addresses

Primary practice location

125 Finney Blvd
Malone, NY 12953-1067

Mailing address

125 Finney Blvd
Malone, NY 12953-1067
Phone (518) 481-8160

Other practice location 1

31 6th St
Malone, NY 12953-1246
Phone (518) 483-3261

Other identifiers 1

IdentifierTypeStateIssuer
03861103MedicaidNY

Other names 1

  • Kristin Michelle Lake Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140826000147 NY Practitioner - Family Practice 4789802299 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Headwaters Health NetworkGroup PAC ID 7416861208, 221 clinicians
Citizen Advocates, IncGroup PAC ID 0648241976, 50 clinicians

Practice addresses (Care Compare)

101 Adirondack Dr
Suite 2
Ticonderoga, NY 12883-9334
Phone (518) 585-6708

125 Finney Blvd
Malone, NY 12953-1067
Phone (518) 481-8160

24 Fairfield Ave
Schroon Lake, NY 12870-0292
Phone (518) 532-7120

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabethtown Community Hospital CurrentSince Oct 1, 2023 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Family Medicine CurrentSince Jan 25, 2022 Accepting new patients
Hudson Headwaters Health Network Family Medicine CurrentSince Jul 15, 2019 Accepting new patients
Citizen Advocates, Inc CurrentSince Feb 2, 2026 Accepting new patients
Citizen Advocates, Inc CurrentSince Feb 2, 2026 Accepting new patients
Hudson Headwaters Health Network Family Medicine CurrentSince Jul 15, 2019 Accepting new patients
Community Care Physicians, PC Past Accepting new patients
Community Care Physicians, PLLC Family Medicine Past Accepting new patients
1019 Wicker Street Operating Company, LLC Past Accepting new patients

Locations

125 Finney Blvd
Malone, NY 12953
Phone (518) 481-8160

15 Francis St
Malone, NY 12953
Phone (518) 483-7801

31 6th St
Malone, NY 12953
Phone (518) 481-5746

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

9 Carey Rd
Queensbury, NY 12804

101 Adirondack Dr
Ste 2
Ticonderoga, NY 12883
Phone (518) 585-6708

102 Race Track Rd
#1
Ticonderoga, NY 12883
Phone (518) 585-6708

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886
  • Direct secure messaging: kristin.mack.1@1823.direct.athenahealth.com

Organizations & group practices 9

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.

Hospital & facility affiliations 9

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": "1312761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1447539507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 FINNEY BLVD",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531067",
            "telephone_number": "518-481-8160",
            "fax_number": "518-481-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 FINNEY BLVD",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531067",
            "telephone_number": "518-481-8160",
            "fax_number": "518-481-8161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 6th St",
            "address_purpose": "LOCATION",
            "city": "Malone",
            "state": "NY",
            "postal_code": "129531246",
            "country_code": "US",
            "telephone_number": "518-483-3261",
            "fax_number": "518-483-3383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-08",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "272786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03861103",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "LAKE",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Malone, NY

Sources for this page

Verify at the official NPI Registry.