Kamryn Alice Mack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009636 Issued in MI

Practice address

22255 Greenfield Rd Ste 400
Southfield, MI 48075-3734

Phone

(248) 849-4880

Fax

(248) 849-4881

NPI assigned

Nov 13, 2018

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

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health Providence HospitalGroup PAC ID 6103738703, 364 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Henry Ford Health Providence Hospital

  • Surgery Physician
  • Southfield, MI
  • NPI 1942265236
  Medicare reassignment Care Compare group
• Henry Ford Health Providence Hospital

  • Pediatrics Physician
  • Southfield, MI
  • NPI 1265497226
  NPD
• Henry Ford Health Providence Hospital

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1922063213
  NPD

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

• Henry Ford Health Providence Hospital

  • General Acute Care Hospital
  • Novi, MI
  • NPI 1144210253
  Care Compare affiliation
• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1619445228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 400",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753734",
            "telephone_number": "248-849-4880",
            "fax_number": "248-849-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 400",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753734",
            "telephone_number": "248-849-4880",
            "fax_number": "248-849-4881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 South Dr Ste 371",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "MI",
            "postal_code": "488583255",
            "country_code": "US",
            "telephone_number": "989-953-5313",
            "fax_number": "989-953-5316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1280 East Campus Dr Central Michigan University",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "MI",
            "postal_code": "488590001",
            "country_code": "US",
            "telephone_number": "989-774-2478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "KAMRYN",
        "middle_name": "ALICE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-13",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Scott Macdonald, RN
• Suzanne Marie Macdonald, LPC, LLP
• Aubrey Macfarlane, LMSW CLINICAL/MACRO
• Christian E Machado, MD
• Desmond Mack
• Levi Mack
• Tyler Mackie
• Lori Mackillop, N.P.
• Gordon E. Mackinnon, PH. D.
• Seth Macomber

• Physician Assistant in Southfield, MI
• Providers in Southfield, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.