Active NPI
Jason Allen Mack, MSWI
- Student in an Organized Health Care Education/Training Program
- Carmichael, CA
National Provider Identifier
1982254686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3637 Mission Ave
Carmichael, CA 95608-2946 - Phone
- (916) 485-4175
- NPI assigned
- Sep 13, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5593 | CA |
Addresses
Primary practice location
3637 Mission Ave
Carmichael, CA 95608-2946
Mailing address
3637 Mission Ave
Carmichael, CA 95608-2946
Phone (916) 485-4175
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5593 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570579200000",
"number": "1982254686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3637 MISSION AVE",
"city": "CARMICHAEL",
"state": "CA",
"postal_code": "956082946",
"telephone_number": "916-485-4175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3637 MISSION AVE",
"city": "CARMICHAEL",
"state": "CA",
"postal_code": "956082946",
"telephone_number": "916-485-4175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "JASON",
"middle_name": "ALLEN",
"credential": "MSWI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-13",
"last_updated": "2019-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "5593",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmichael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.