Organization Active NPI

Mark S. McMahon M.D. PC

  • Specialist
  • New York, NY
National Provider Identifier
1811260714
Registry record updated Feb 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MARK S. MCMAHON M.D. PC
Practice address
876 Park Ave
New York, NY 10075-1832
Phone
(212) 717-1405
Fax
(212) 396-3277
NPI assigned
Feb 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2012

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

Authorized official

Name
Michelle Carrero
Title
Office Manager/Medical Biller
Phone
(212) 717-1405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

876 Park Ave
New York, NY 10075-1832

Mailing address

876 Park Ave
New York, NY 10075-1832
Phone (212) 717-1405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120327000840 NY Part B Supplier - Clinic/Group Practice 5799945879 Receives reassigned benefits from 1 practitioner
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329955200000",
    "number": "1811260714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "876 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751832",
            "telephone_number": "212-717-1405",
            "fax_number": "212-396-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "876 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751832",
            "telephone_number": "212-717-1405",
            "fax_number": "212-396-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK S. MCMAHON M.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-23",
        "status": "A",
        "authorized_official_last_name": "CARRERO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER/MEDICAL BILLER",
        "authorized_official_telephone_number": "212-717-1405"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.