Individual provider Active NPI

Mark McGill

  • Dentist
  • Yakima, WA
National Provider Identifier
1447550108
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00007332 Issued in WA
Practice address
602 E Nob Hill Blvd
Yakima, WA 98901-3534
Phone
(509) 248-3334
Fax
(509) 453-6144
NPI assigned
Oct 28, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7332 WA
Dentist 122300000X DE00007332 WA Primary

Addresses

Primary practice location

602 E Nob Hill Blvd
Yakima, WA 98901-3534

Mailing address

PO Box 190
Toppenish, WA 98948-0190
Phone (509) 865-2395

Other identifiers 1

IdentifierTypeStateIssuer
1037060MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241212002068 WA Practitioner - Dentist 3577099654 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE00007332WAMDDentist
7332WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Farm Workers Clinic CurrentSince Oct 14, 2024 Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Oct 14, 2024 Accepting new patients
Yakima Valley Farm Workers Clinic Current Accepting new patients

Locations

3801 Kern Rd
Yakima, WA 98902
Phone (509) 574-3200

602 E Nob Hill Blvd
Yakima, WA 98901
Phone (509) 248-3334

2205 W Lincoln Ave
Yakima, WA 98902
Phone (509) 469-6305

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.

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1447550108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989480190",
            "telephone_number": "509-865-2395",
            "fax_number": "509-865-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 E NOB HILL BLVD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989013534",
            "telephone_number": "509-248-3334",
            "fax_number": "509-453-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGILL",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-28",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "7332",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00007332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1037060",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.