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CHARISSE L MACK PA NPI 1801973615


NPI Information

NPI: 1801973615
Provider Name: CHARISSE L MACK, PA
Classification: Physician Assistant - 363A00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
6140 CURTISIAN AVE
STE 400
BOISE, ID
ZIP 83704
Phone: (208) 367-3500
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Charisse L Mack, PA is a physician assistant in Boise, ID with 18 years of experience. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Charisse L Mack, PA NPI is 1801973615. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6140 CURTISIAN AVE
STE 400
BOISE, ID
ZIP 83704-880
Phone: (208) 367-3500
Fax: (208) 367-2968

The NPI 1801973615 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Insertion of device into intervertebral disc space of spine and fusion of vertebrae (HCPCS:22853)
  • Partial removal of middle spine bone with release of spinal cord and/or nerves (HCPCS:63047)
  • Partial removal of spine bone with release of spinal cord and/or nerves (HCPCS:63048)
  • Fusion of spine bones, posterior or posterolateral approach (HCPCS:22614)
  • Insertion of posterior spinal instrumentation for spinal stabilization, 3 to 6 vertebral segments (HCPCS:22842)

The enumeration date for this NPI number is 11/1/2006 and was last updated on 3/4/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363AS0400XPhysician AssistantSurgicalPA632IDAHONo
2363A00000XPhysician AssistantPA-632IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q76267MEDICARE UPINIDAHO
216681401MEDICARE PINIDAHO
3PAD65OTHERIDAHOBLUE CROSS OF ID
4000010158697OTHERIDAHOBLUE SHIELD OF ID
5807590500MEDICAIDIDAHO
60214786OTHERIDAHOSTATE OF WA DOL
7P00465610MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.