Individual provider Active NPI

Peter Erlich Mackay, DO

  • Family Medicine Physician
  • Crosby, MN
National Provider Identifier
1972587723
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35060 Issued in MN
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

Updated by the provider on Nov 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
803077400MedicaidMN

Electronic endpoints 2

TypeEndpointUseAffiliation
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

LicenseStateTypeSpecialty
35060MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Lakes Medical Clinic PA Family Medicine CurrentSince Oct 19, 2000 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

  • Direct secure messaging: 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.

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.

Verify at the official NPI Registry.