Kenneth J Mack, M.D.

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

31065 Issued in WI

Practice address

600 Highland Ave
Madison, WI 53792-0001

Phone

(608) 890-6500

NPI assigned

Dec 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Neurology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Wisconsin Medical Foundation IncGroup PAC ID 6608785464, 2,537 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmack137378@ehrdirect.mayoclinicmsg.org

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.

• University of Wisconsin Medical Foundation, Inc

  • Multi-Specialty Clinic/Center
  • Middleton, WI
  • NPI 1598784555
  Medicare reassignment Care Compare group NPD
• Mayo Clinic

  • Multi-Specialty Clinic/Center
  • Rochester, MN
  • NPI 1922074434
  Medicare reassignment NPD
• University of Wisconsin Medical Foundation, Inc

  • Health Educator
  • Madison, WI
  • NPI 1487414082
  NPD
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD
• Mayo Clinic

  • Multi-Specialty Clinic/Center
  • Rochester, MN
  • NPI 1538568928
  NPD
• University of Wisconsin Medical Foundation Inc

  • Durable Medical Equipment & Medical Supplies
  • Cross Plains, WI
  • NPI 1174583363
  NPD (past)

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1689651044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001",
            "telephone_number": "608-890-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "44001",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "31065",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MN",
            "license": "44001",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "WI",
            "license": "31065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather M Machkovech, MD, PHD
• Susan Jean Machkovitz, PH.D.
• Kaci Maciosek
• Dave Mack
• Kelly S Mack, APRN BC
• Lianna Mack, MD
• Tiffany L Mack, PA
• Michelle Mary Kolton Mackay, M.D.
• Ethan Laghi Mackenzie, MD
• Anne Louise Mackey, R.N.

• Neurology with Special Qualifications in Child Neurology Physician in Madison, WI
• Providers in Madison, WI by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.