Kyle Mack

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA.18886-NP Issued in OH

Practice address

3999 Richmond Rd
Beachwood, OH 44122-6046

Phone

(216) 593-5532

NPI assigned

Mar 7, 2016

Last updated

Mar 7, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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 OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmack27660@ehrdirect.uhhospitals.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.

• University Hospitals Ahuja Medical Center, Inc

  dba UH Ahuja Medical Center

  • General Acute Care Hospital
  • Beachwood, OH
  • NPI 1609189604
  Medicare reassignment NPD
• University Hospitals Ahuja Medical Center

  dba University Hospitals Ahuja Medical Center Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Beachwood, OH
  • NPI 1326522913
  NPD
• University Hospitals Ahuja Medical Center

  • Nurse Practitioner
  • Beachwood, OH
  • NPI 1982088027
  NPD
• Northern Ohio Internal Medicine Associates, Inc.

  • Internal Medicine Physician
  • Warrensville Heights, OH
  • NPI 1831367820
  NPD (past)

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1669832424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3999 RICHMOND RD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441226046",
            "telephone_number": "216-593-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 RICHMOND RD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441226046",
            "telephone_number": "216-593-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-07",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.18886-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirsten Trotter Lynch, MD
• Timothy J Lynn, DPT
• Jennifer Dawn Lyons, MS, RDN, LD
• Lisa Douglass Lystad, MD
• Wendy Maayan
• Leroy Mack Jr., RN
• Cynthia S Mackey, CNP
• Carol Hyman Macknin, M.D.
• Brinn Maclellan
• Taylor Macwhade

• Family Nurse Practitioner in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.