Active NPI
Lindsay Mack
- Dentist
- Sunnyside, WA
National Provider Identifier
1750835849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60657452
- Practice address
- 1721 E Lincoln Ave
Sunnyside, WA 98944-2478 - Phone
- (509) 837-7178
- Fax
- (509) 837-3117
- NPI assigned
- Aug 7, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DE60657452 | WA | Primary |
Addresses
Primary practice location
1721 E Lincoln Ave
Sunnyside, WA 98944-2478
Mailing address
1721 E Lincoln Ave
Sunnyside, WA 98944-2478
Phone (509) 837-7178
Other names 1
- Miss Lindsay A Kelstrom
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lmack28877@yvfwc.direct-ci.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190307002350 | WA | Order and Referring Only - Dentist | 5294074399 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- lmack28877@yvfwc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616371200000",
"number": "1750835849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1721 E LINCOLN AVE",
"city": "SUNNYSIDE",
"state": "WA",
"postal_code": "989442478",
"telephone_number": "509-837-7178",
"fax_number": "509-837-3117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1721 E LINCOLN AVE",
"city": "SUNNYSIDE",
"state": "WA",
"postal_code": "989442478",
"telephone_number": "509-837-7178",
"fax_number": "509-837-3117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "LINDSAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-07",
"last_updated": "2021-03-22",
"certification_date": "2021-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60657452",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lmack28877@yvfwc.direct-ci.com",
"affiliation": "N",
"endpointDescription": "YVFWC Direct Email Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "1721 E Lincoln Ave",
"city": "Sunnyside",
"state": "WA",
"country_code": "US",
"postal_code": "989442478",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "LINDSAY",
"last_name": "KELSTROM",
"middle_name": "A",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sunnyside, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.