Gordon K Mack, MD

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

M-12151 Issued in ID

Practice address

100 E Idaho St
Suite 304
Boise, ID 83712-6267

Phone

(208) 381-7384

Fax

(208) 381-7387

NPI assigned

Sep 8, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Pediatric Medicine

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

87.3 of 100Reported as group

Quality

81.29

Promoting interoperability

100

Improvement activities

40

Cost

76.37

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gmack18856@direct.slhs.org

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment Care Compare group NPD
• Peds Diagnostic Cardiology

  • Pediatric Cardiology Physician
  • Salt Lake City, UT
  • NPI 1710016340
  NPD (past)

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1982937058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "SUITE 304",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126267",
            "telephone_number": "208-381-7384",
            "fax_number": "208-381-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "GORDON",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-08",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "UT",
            "license": "7320207-1205",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ID",
            "license": "M-12151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982937058",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kera Macfarlane
• Jose Machado, CSFA
• Julane Machado
• Joseph Machtinger, PMHNP-BC
• Charisse L Mack, PA
• Kimball Gray Mack, DMD
• Adam J Mackenzie, PHD
• Debra Mackenzie
• Joshua J Mackie, CRNA
• Cassandra Natasha Mackiewicz, IBCLC

• Pediatric Cardiology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pediatric Cardiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; 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.