Thomas J Mack, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016-003-689 Issued in IL

Practice address

6721 West 40TH Street
Stickney, IL 60402-4171

Phone

(708) 387-0633

Fax

(708) 387-0638

NPI assigned

Jun 16, 2005

Last updated

Apr 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stickney Public Health DistrictGroup PAC ID 4183798127, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Stickney Public Health District

  • State or Local Public Health Clinic/Center
  • Burbank, IL
  • NPI 1578765426
  Medicare reassignment Care Compare group
• Brookfield Podiatry Center

  • Podiatrist
  • Bensenville, IL
  • NPI 1245415850
  NPD Authorized official
• Podiatric Management Systems LLC

  • Primary Podiatric Medicine Podiatrist
  • Lake Zurich, IL
  • NPI 1396968053
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1548265689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21041 W SNOWBERRY LN",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605446413",
            "telephone_number": "630-390-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6721 WEST 40TH STREET",
            "city": "STICKNEY",
            "state": "IL",
            "postal_code": "604024171",
            "telephone_number": "708-387-0633",
            "fax_number": "708-387-0638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5635 State Rd",
            "address_purpose": "LOCATION",
            "city": "Burbank",
            "state": "IL",
            "postal_code": "604592051",
            "country_code": "US",
            "telephone_number": "708-424-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016-003-689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016003689",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Desiree Gonzalez
• Jessenia Gonzalez
• Cristopher Guzman, PHARMD
• Emily Jacobs, MD
• Tami Lynn Jimenez, LCSW
• Daniel John Maturo, D.D.S.
• Milan Meghpara, PHARMD
• Manuel E Murillo Ruiz, LMT
• Scott Robert Musil, DDS
• Prakash Chand Navni, D.P.T

• Podiatrist in Stickney, IL
• Providers in Stickney, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; 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.