Soundra D Mackavich, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2488088 Issued in MI

Practice address

44405 Woodward Ave
Pontiac, MI 48341-5023

Phone

(248) 858-6591

NPI assigned

Nov 29, 2009

Last updated

Nov 29, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

M15 Family Care PCGroup PAC ID 3072818624, 2 clinicians

M15 Urgent Care PCGroup PAC ID 9830363837, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smackavich117187@direct.hurleymc.com
• Direct secure messaging: smackavich1806759@direct.trinity-health.org

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.

• M15 Urgent Care PC

  • Emergency Medicine Physician
  • Ortonville, MI
  • NPI 1194017673
  Medicare reassignment Care Compare group NPD
• M15 Family Care PC

  • Internal Medicine Physician
  • Ortonville, MI
  • NPI 1558733204
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1259452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259452800000",
    "number": "1578891792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 GRIXDALE LN",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283430",
            "telephone_number": "248-681-3622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44405 WOODWARD AVE",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415023",
            "telephone_number": "248-858-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKAVICH",
        "first_name": "SOUNDRA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-29",
        "last_updated": "2009-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "2488088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn E. Howell MD, PC (North Oakland Vein Center)
• Lynn Optical Associates PC (Lynn & Mall Optical Center)
• David Lynn
• M a Verardi MD PC
• Michael Mack
• Tara Lee Maclaren-Gibson, CRNA
• Lauren Macleod, MA QMHP
• Jennifer Macquarrie
• Alexander Samuel Madgy, MD
• Julayne Valrie Magee

• Family Nurse Practitioner in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2009; 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.