Provider Type Icon

MR. MARTY PHILLIP DACK NP NPI 1871686337


NPI Information

NPI: 1871686337
Provider Name: MR. MARTY PHILLIP DACK, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1703 E MICHIGAN AVE
LANSING, MI
ZIP 48912
Phone: (517) 913-3860
Get Directions

MR. Marty Phillip Dack, NP is a family nurse practitioner in Lansing, MI with 21 years of experience. MR. Marty Phillip Dack, NP NPI is 1871686337. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1703 E MICHIGAN AVE
LANSING, MI
ZIP 48912-841
Phone: (517) 913-3860
Fax: (517) 484-6864

The NPI 1871686337 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.

  • Dialysis services (2-3 physician visits per month), patient 20 years of age and older (HCPCS:90961)

The enumeration date for this NPI number is 10/2/2006 and was last updated on 8/26/2010.


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
1363LF0000XNurse PractitionerFamily4704222015MICHIGANYes

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
11057822OTHERMICHIGANMCLAREN HEALTH PLAN-MEDICAID
2P00367059OTHERMICHIGANRAILROAD MEDICARE
3200000006547OTHERMICHIGANPHP FAMILYCARE
44950304MEDICAIDMICHIGAN
5Q12377MEDICARE UPINMICHIGAN
61057822OTHERMICHIGANMCLAREN HEALTH PLAN-COMMERCIAL
75008702500OTHERMICHIGANBLUE CROSS BLUE SHILED
8N55170013OTHERMICHIGANMEDICARE PLUS BLUE
97952506OTHERMICHIGANAETNA
10N55170013MEDICARE PINMICHIGAN
111057822OTHERMICHIGANMCLAREN HEALTH ADVANTAGE
12200000006547OTHERMICHIGANPHP

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.