Active NPI
Erica Jayne Mack, CNP
- Family Medicine Physician
- Lancaster, OH
National Provider Identifier
1619580693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- CNP023991
- Practice address
- 542 W Mulberry St
Lancaster, OH 43130-2907 - Phone
- (740) 407-9240
- NPI assigned
- Aug 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CNP023991 | OH | Primary |
Addresses
Primary practice location
542 W Mulberry St
Lancaster, OH 43130-2907
Mailing address
542 W Mulberry St
Lancaster, OH 43130-2907
Phone (740) 407-9240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CNP023991 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP023991 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1619580693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "542 W MULBERRY ST",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431302907",
"telephone_number": "740-407-9240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "542 W MULBERRY ST",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431302907",
"telephone_number": "740-407-9240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "ERICA",
"middle_name": "JAYNE",
"credential": "CNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "CNP023991",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CNP023991",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.