Black Hills Family Practice Clinic PS

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLACK HILLS FAMILY PRACTICE CLINIC PS

Practice address

332 S Birch St
McCleary, WA 98557-9522

Phone

(360) 495-3475

NPI assigned

Oct 13, 2006

Last updated

Oct 13, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Edward R Macke, MD

Title

President

Phone

(360) 495-3475

Specialties & licenses 1

Addresses

Other identifiers 10

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1467542399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "985570068",
            "telephone_number": "360-495-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 S BIRCH ST",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "985579522",
            "telephone_number": "360-495-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS FAMILY PRACTICE CLINIC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "MACKE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-495-3475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SLI",
            "identifier": "15628",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "008N",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIFORM",
            "identifier": "75243",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY H",
            "identifier": "1009515",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "MA8267",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC CARE",
            "identifier": "95958",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "QMXPR0055448",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1252402",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "8009961",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Baca, COUNSELOR
• Brandy Ellen Bacon
• Bogumila Bartnicki, REGISTERED NURSE
• Kristina Leigh Beith
• Robert Eugene Billings, M.D.
• Damian Bollweg
• Jennifer Bowen, RN
• Marissa Pableo Bratton
• Lindsey Sue Brightman, DNP, ARNP, FNP-C
• Kathleen Brix, REGISTERED NURSE

• Family Medicine Physician in McCleary, WA
• Providers in McCleary, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.