Amanda Nichole McConnell Mack, DO

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

34.010575 Issued in OH

Practice address

90 Jackson Pike
Gallipolis, OH 45631-1560

Phone

(740) 446-5763

Fax

(740) 446-5573

NPI assigned

Apr 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Amanda Nichole McConnell Professional name

Electronic endpoints 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

NeurologyAlso: Sleep Medicine

Education

Ohio University, College of Osteopathic Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Holzer Clinic LLCGroup PAC ID 5890606008, 266 clinicians

Premier Therapy and Health Centers IncGroup PAC ID 7416859574, shared by 6 NPIs, 263 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holzer Medical Center Hospital, Gallipolis, OH, CCN 360054
• Holzer Medical Center Jackson Hospital, Jackson, OH, CCN 361320
• Ohiohealth O'Bleness Hospital Hospital, Athens, OH, CCN 360014
• Marietta Memorial Hospital Hospital, Marietta, OH, CCN 360147
• Cabell Huntington Hospital, Inc Hospital, Huntington, WV, CCN 510055

Merit-based Incentive Payment System (MIPS)

Final score

97.57 of 100Reported as individual

Quality

88.81

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.mcconnell.mack.1@17389.direct.athenahealth.com

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.

• Holzer Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gallipolis, OH
  • NPI 1508817248
  Medicare reassignment Care Compare group NPD
• I Path LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Gallipolis, OH
  • NPI 1942525563
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Mary Rutan Hospital

  • Family Medicine Physician
  • West Liberty, OH
  • NPI 1003875949
  NPD (past)

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

• Holzer Hospital Foundation

  • Rural Acute Care Hospital
  • Gallipolis, OH
  • NPI 1942256888
  Care Compare affiliation
• Holzer Medical Center Jackson

  • Critical Access Hospital
  • Jackson, OH
  • NPI 1669410940
  Care Compare affiliation
• Marietta Memorial Hospital

  • General Acute Care Hospital
  • Marietta, OH
  • NPI 1215936927
  Care Compare affiliation
• Sheltering Arms Hospital Foundation, Inc.

  • General Acute Care Hospital
  • Athens, OH
  • NPI 1710913462
  Care Compare affiliation
• Cabell Huntington Hospital Inc

  • General Acute Care Hospital
  • Huntington, WV
  • NPI 1073518007
  Care Compare affiliation

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1740424076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5763",
            "fax_number": "740-446-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5763",
            "fax_number": "740-446-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL MACK",
        "first_name": "AMANDA",
        "middle_name": "NICHOLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-30",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "OH",
            "license": "34.010575",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "34.010575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810024041",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0069462",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.mcconnell.mack.1@17389.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "90 Jackson Pike",
            "city": "Gallipolis",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456311560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.mcconnell.mack.1@17389.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "90 Jackson Pike",
            "city": "Gallipolis",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456311560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "MCCONNELL",
            "middle_name": "NICHOLE",
            "credential": "DO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tara McClary, PHARMD
• Lyndsai McClaskey, RN.351576
• Carrie E McClure
• Dustin Lee McCombs
• Kasidy McCombs, FNP
• Stephen Andrew McCormick, R.N.
• Eugenia Kay McCoy, CRNA, DMPNA
• Kristina Marie McDaniel
• Nicholas McDonald, M.D.
• Amy Nichole McFall

• Neurology Physician in Gallipolis, OH
• Providers in Gallipolis, OH by specialty
• Neurology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.