Tianna Marie Mack, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

210-T1 Issued in WY

Practice address

820 E 17TH St
Cheyenne, WY 82001-4714

Phone

(307) 632-2434

NPI assigned

May 12, 2022

Sex

Female

Sole proprietor

Yes

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 CO

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

Family Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uptown Community Health Center IncGroup PAC ID 4183090152, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Hospital Hospital, Denver, CO, CCN 060028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Uptown Community Health Center Inc

  • Family Medicine Physician
  • Denver, CO
  • NPI 1598408973
  Medicare reassignment Care Compare group
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Denver, CO
  • NPI 1417946021
  NPD (past)

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

• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Littleton, CO
  • NPI 1164071296
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Denver, CO
  • NPI 1417946021
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Northglenn, CO
  • NPI 1427607464
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Aurora, CO
  • NPI 1619526746
  Care Compare affiliation

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1912643891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E 17TH ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014714",
            "telephone_number": "307-632-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E 17TH ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014714",
            "telephone_number": "307-632-2434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "418 W 31st St",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820012527",
            "country_code": "US",
            "telephone_number": "303-503-2310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "TIANNA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-07-11",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "210-T1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cecily Ellen Lykes, D.O.
• Maurice I Lyons, D.O.
• Laura J Macdougall, MSW, PCSW
• Randall Scott Macey, PCSW
• Chinna L. Mack, MSW, LCSW
• Colin Ian Mackay, HAD
• Sara L Macke, MSW, LCSW
• Charles Edward Mackey, MD
• Denise D Macleod, APN
• Elawna Macmillan

• Family Medicine Physician in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Family Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.