Active NPI
Peter Erlich Mackay, DO
- Family Medicine Physician
- Crosby, MN
National Provider Identifier
1972587723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35060
- Practice address
- 320 E Main St
Cuyuna Regional Medical Center
Crosby, MN 56441-1645 - Phone
- (218) 546-7000
- Fax
- (218) 545-4456
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35060 | MN | Primary |
Addresses
Primary practice location
320 E Main St
Cuyuna Regional Medical Center
Crosby, MN 56441-1645
Mailing address
320 East Main St
Cuyuna Regional Medical Center
Crosby, MN 56441
Phone (218) 546-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 803077400 | Medicaid | MN |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pmackay153906@excellian.direct.allina.com | Direct | Cuyuna Regional Medical Center |
| Direct Messaging Address | pmackay153906@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35060 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Lakes Medical Clinic PA | Family Medicine | Current | Accepting new patients |
Locations
200 Bunker Hill Dr
Aitkin, MN 56431
Phone (218) 927-2121
318 E Main St
Crosby, MN 56441
Phone (218) 546-8375
320 E Main St
Crosby, MN 56441
Phone (218) 546-7000
Interoperability endpoints
- pmackay153906@excellian.direct.allina.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Crosby, MN
- NPI 1881621761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605744000000",
"number": "1972587723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 EAST MAIN ST",
"address_2": "CUYUNA REGIONAL MEDICAL CENTER",
"city": "CROSBY",
"state": "MN",
"postal_code": "56441",
"telephone_number": "218-546-7000",
"fax_number": "218-545-4456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 E MAIN ST",
"address_2": "CUYUNA REGIONAL MEDICAL CENTER",
"city": "CROSBY",
"state": "MN",
"postal_code": "564411645",
"telephone_number": "218-546-7000",
"fax_number": "218-545-4456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKAY",
"first_name": "PETER",
"middle_name": "ERLICH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2020-11-19",
"certification_date": "2020-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "35060",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "803077400",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pmackay153906@excellian.direct.allina.com",
"affiliation": "Y",
"affiliationName": "Cuyuna Regional Medical Center",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "pmackay153906@excellian.direct.allina.com",
"address_1": "320 E Main St",
"city": "Crosby",
"state": "MN",
"country_code": "US",
"postal_code": "564411645",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pmackay153906@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "PDA/PDF/TXT",
"address_1": "320 E Main St",
"city": "Crosby",
"state": "MN",
"country_code": "US",
"postal_code": "564411645",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Crosby, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.