Active NPI
Mack McCoy
- Massage Therapist
- Irvine, CA
National Provider Identifier
1679248082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 74342
- Practice address
- 2 Wharton CT
Irvine, CA 92617-4108 - Phone
- (949) 371-6225
- NPI assigned
- Aug 9, 2021
- Last updated
- Aug 9, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 74342 | CA | Primary |
Addresses
Primary practice location
2 Wharton CT
Irvine, CA 92617-4108
Mailing address
2 Wharton CT
Irvine, CA 92617-4108
Phone (949) 371-6225
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74342 | Other | CA | CAMTC CERTIFICATION |
| 1445509 | Other | AMTA MEMBERSHIP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74342 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1679248082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 WHARTON CT",
"city": "IRVINE",
"state": "CA",
"postal_code": "926174108",
"telephone_number": "949-371-6225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 WHARTON CT",
"city": "IRVINE",
"state": "CA",
"postal_code": "926174108",
"telephone_number": "949-371-6225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOY",
"first_name": "MACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-09",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "74342",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAMTC CERTIFICATION",
"identifier": "74342",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMTA MEMBERSHIP",
"identifier": "1445509",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.