Bradley J Mack, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

PENDING Issued in NE

Practice address

2700 W Norfolk Ave
Norfolk, NE 68701-4438

Phone

(402) 371-4880

Fax

(402) 644-7647

NPI assigned

May 2, 2019

Last updated

May 2, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, TX2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grasshopper Anesthesia Services PLLCGroup PAC ID 3072882315, 70 clinicians

Desert Peak Anesthesia, LLCGroup PAC ID 6002884996, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain West Medical Center Hospital, Tooele, UT, CCN 460014

Medicare enrollment (NPD)

Enrolled

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.

• Grasshopper Anesthesia Services PLLC

  • Certified Registered Nurse Anesthetist
  • Nacogdoches, TX
  • NPI 1932635752

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Deseret Peak Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Tooele, UT
  • NPI 1518972280
  Medicare reassignment Care Compare group

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

• Tooele Hospital Corporation

  dba Mountain West Medical Center

  • General Acute Care Hospital
  • Tooele, UT
  • NPI 1124090659
  Care Compare affiliation

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1881259182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 W NORFOLK AVE",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687014438",
            "telephone_number": "402-371-4880",
            "fax_number": "402-644-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 W NORFOLK AVE",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687014438",
            "telephone_number": "402-371-4880",
            "fax_number": "402-644-7647"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 N 27th St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "NE",
            "postal_code": "687014457",
            "country_code": "US",
            "telephone_number": "402-644-7262",
            "fax_number": "402-644-7227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NE",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David P Lux, MD
• Melanie J Lynch, R.P.
• Natalie Lynch, DO, MA
• Jillian Paige Lynott
• Chad Maas, PHARMD, BCGP
• Addison Adair Mackling
• Tre Michael Madison
• Desteny Magana Magana
• Pamela Magana-Cancino
• Belen Magana

• Certified Registered Nurse Anesthetist in Norfolk, NE
• Providers in Norfolk, NE by specialty
• Certified Registered Nurse Anesthetist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.