Keisha Mack, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

331233-1 Issued in NY

Practice address

1 Penn PLZ FL 8
New York, NY 10119-0899

Phone

(917) 991-9526

NPI assigned

Oct 20, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Keisha Smith Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arcadian Medical Health PCGroup PAC ID 6800388372, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nyack Hospital Hospital, Nyack, NY, CCN 330104

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

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.

• Care Connect Medical P.C.

  • General Practice Physician
  • Tarrytown, NY
  • NPI 1457032328
  Medicare reassignment NPD
• Genesis Medical Health PC

  • General Practice Physician
  • Spring Valley, NY
  • NPI 1295043099
  Medicare reassignment NPD
• Arcadian Medical Health PC

  • General Practice Physician
  • Spring Valley, NY
  • NPI 1285432989
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Montefiore Nyack Hospital

  • General Acute Care Hospital
  • Nyack, NY
  • NPI 1104808062
  Care Compare affiliation

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1487964631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PENN PLZ FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101190899",
            "telephone_number": "917-991-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PENN PLZ FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101190899",
            "telephone_number": "917-991-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KEISHA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-20",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00289600",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "331233-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEISHA",
            "last_name": "SMITH",
            "prefix": "MISS",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin Mack
• Ethan Andrew Mack, MD, PHD
• Jason Mack, MD
• Jennifer T Mack
• Jeremy R Mack, MD
• Lian Alana Mack, MD
• Lorina Mack, LMSW
• Nina Grillo-Balthrop Mack, MA, NBC-HWC
• Patricia Fogarty Mack, MD
• Richard J Mack, LCSW

• Family Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.

Verify at the official NPI Registry.