Jody Mack, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MED-PAC-LIC-61430 Issued in MT

Practice address

947 S 5TH St
Montrose, CO 81401-5716

Phone

(970) 249-2421

Fax

(970) 249-1203

NPI assigned

Nov 14, 2007

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 1

Other names 1

• Jody Rutz Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MT

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

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jodym@intermountain.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.

• St Peter's Health

  • General Acute Care Hospital
  • Helena, MT
  • NPI 1205025145
  Medicare reassignment
• St. Peter's Health

  dba St Peters Medical Office Building

  • Family Medicine Physician
  • Helena, MT
  • NPI 1083869390
  NPD
• St. Peter's Health

  dba Sound Health Imaging

  • Radiology Clinic/Center
  • Butte, MT
  • NPI 1194785154
  NPD
• Pediatric Associates Prof LLC

  • Rural Health Clinic/Center
  • Delta, CO
  • NPI 1043016124
  NPD (past)
• Pediatric Associates Prof LLC

  dba The Pediatric Associates

  • Pediatrics Physician
  • Montrose, CO
  • NPI 1548261324
  NPD (past)

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1760663140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 S 5TH ST",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015716",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "947 S 5TH ST",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015716",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "242 Cottonwood St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Delta",
            "state": "CO",
            "postal_code": "814164404",
            "country_code": "US",
            "telephone_number": "970-874-7552",
            "fax_number": "970-249-1203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "906 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814014226",
            "country_code": "US",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "JODY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2457",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MT",
            "license": "MED-PAC-LIC-61430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67538746",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JodyM@intermountain.org",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "3240 Dredge Dr",
            "city": "Helena",
            "state": "MT",
            "country_code": "US",
            "postal_code": "596020548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JODY",
            "last_name": "RUTZ",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Benjamin Lott, PHARMD
• Amy Irene Page Lowy, RD
• Loyal Mental Health (Colorado Direct Psychiatric Care)
• Keith Lundberg, D.C.
• Martin S Lutz
• Avery Mackenzie, M.D.
• Tara Madden, D.C.
• Douglas Maddy
• Jenina T Madrid, MS, NCC
• Ulises Madrigal Jr.

• Medical Physician Assistant in Montrose, CO
• Providers in Montrose, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.