John B Mack, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

H6396 Issued in TX

Practice address

707 Hollybrook Dr
Longview, TX 75605-2410

Phone

(903) 753-4666

Fax

(903) 753-6634

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

General Surgery

Education

Baylor College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Longview Regional Medical Center Hospital, Longview, TX, CCN 450702
• Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.mack.1@23550.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.

• Associated Clinicians of East Texas

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1932640349

  Surgery

  Medicare reassignment Care Compare group NPD
• Associated Clinicians of East Texas

  • Community/Retail Pharmacy
  • Longview, TX
  • NPI 1447451406
  NPD (past)
• Longview Specialty Physicians

  • Durable Medical Equipment & Medical Supplies
  • Longview, TX
  • NPI 1306063490
  NPD (past)

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

• Christus Good Shepherd Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1124092036
  Care Compare affiliation
• Longview Medical Center LP

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1528026267
  Care Compare affiliation

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1801826151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-232-8501",
            "fax_number": "903-232-8226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 HOLLYBROOK DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052410",
            "telephone_number": "903-753-4666",
            "fax_number": "903-753-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JOHN",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "H6396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099133305",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rai Machin, M.A., LPC-INTERN
• Mack and Hansen Orthodontics, PLLC
• Mack Dental
• Baleigh Paige Mack, DDS
• James Andrew Mack, DDS
• Kelly Wade Mack, DDS
• Madison Mack, DDS
• Samuel Christopher Mack, D.D.S.
• Shundra Mack
• Simon Lucas Mack, D.D.S.

• Surgery Physician in Longview, TX
• Providers in Longview, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; 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.