Glenn Andrew Mahoney, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

12451 Issued in GA

Practice address

8910 Vernon Road
Lake Stevens, WA 98258

Phone

(425) 335-0966

Fax

(425) 335-5145

NPI assigned

Feb 8, 2006

Last updated

Sep 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA, GA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076
• Emory Hillandale Hospital Hospital, Lithonia, GA, CCN 110226
• Emory University Hospital Hospital, Atlanta, GA, CCN 110010

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cep America LLC

  dba Vituity

  • Emergency Medicine Physician
  • Lithonia, GA
  • NPI 1124073721
  Medicare reassignment Care Compare group
• Cep America LLC

  dba Vituity

  • Emergency Medicine Physician
  • Edmonds, WA
  • NPI 1447484274
  Medicare reassignment NPD
• Optum Care Washington PLLC

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1831186766
  Medicare reassignment NPD
• Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Marysville, WA
  • NPI 1194428425
  NPD
• Cep America LLC

  dba Vituity

  • Emergency Medicine Physician
  • Decatur, GA
  • NPI 1215982814
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD

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

• Dekalb Medical Center, Inc.

  dba Emory Decatur Hospital

  • General Acute Care Hospital
  • Decatur, GA
  • NPI 1093716979
  Care Compare affiliation
• Dekalb Medical Center, Inc.

  dba Dekalb Medical Center at Hillandale

  • General Acute Care Hospital
  • Lithonia, GA
  • NPI 1962403865
  Care Compare affiliation
• Emory University

  dba Emory University Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1588640692
  Care Compare affiliation
• Emory University

  dba Emory University Hospital At Wesley Woods

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1770560294
  Care Compare affiliation

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1841263365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOYT AVENUE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98201",
            "telephone_number": "425-339-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8910 VERNON ROAD",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "98258",
            "telephone_number": "425-335-0966",
            "fax_number": "425-335-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "GLENN",
        "middle_name": "ANDREW",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PAC942",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60042438",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "12451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507753",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507754",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.