William Jacob Mack IV, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

A104088 Issued in CA

Practice address

1520 San Pablo St Ste 3800
Los Angeles, CA 90033-5328

Phone

(323) 442-5720

NPI assigned

May 1, 2008

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

NeurosurgeryAlso: Diagnostic Radiology

Education

Columbia University College of Physicians and Surgeons, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Keck Hospital of Usc Hospital, Los Angeles, CA, CCN 050696
• Usc Kenneth Norris Jr Cancer Hospital Hospital, Los Angeles, CA, CCN 050660
• Usc Verdugo Hills Hospital Hospital, Glendale, CA, CCN 050124
• Los Angeles General Medical Center Hospital, Los Angeles, CA, CCN 050373

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: william.mack@direct.usc.edu

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.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306

  Neurological Surgery

  Medicare reassignment Care Compare group NPD
• Usc Care Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD
• UCLA Radiology Medical Group

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1881670248
  NPD (past)

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

• County of Los Angeles

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1598773715
  Care Compare affiliation
• Keck Medical Center of Usc

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1013514199
  Care Compare affiliation
• Keck Medical Center of Usc

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1417554528
  Care Compare affiliation
• Usc Verdugo Hills Hospital

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1033716147
  Care Compare affiliation

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1811163793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 3800",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335328",
            "telephone_number": "323-442-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "WILLIAM",
        "middle_name": "JACOB",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A104088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "william.mack@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St Ste 3800",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Latoreia R Mack
• Lynn Mack
• Michael Mack, MFT
• Robert McKensey Mack, LCSW, PPS
• Valerie Alida Mack, L.AC.
• Michael G. Mackanic, MD
• Stephanie Lind Mackanic, DO
• Karen Ew Mackasek, PT
• Tully Mackay-Tisbert
• Susan J Mackensen, M.D.

• Neurological Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Neurological Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.