Mr Brian Mack, FNP-C is a medicare enrolled "Nurse Practitioner" physician in San Francisco, California. His current practice location is
655 Montgomery St Ste 810, San Francisco, California. You can reach out to his office (for appointments etc.) via phone at
(844) 847-8216.
Mr Brian Mack is licensed to practice in North Carolina (license number 5011498) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1063979128.
Physician's Profile
| Full Name | Mr Brian Mack |
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| Gender | Male |
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| Speciality | Nurse Practitioner |
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| Location | 655 Montgomery St Ste 810, San Francisco, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1063979128
- Provider Enumeration Date: 02/25/2019
- Last Update Date: 12/19/2023
Medicare PECOS Information:
- PECOS PAC ID: 2062753551
- Enrollment ID: I20190410001753
Medical Identifiers
Medical identifiers for Mr Brian Mack such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1063979128 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207RP1001X | Internal Medicine - Pulmonary Disease | 5011498 (North Carolina) | Secondary |
| 207RS0012X | Internal Medicine - Sleep Medicine | 5011498 (North Carolina) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | 5011498 (North Carolina) | Secondary |
| 363L00000X | Nurse Practitioner | 5011498 (North Carolina) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Brian Mack allows following entities to bill medicare on his behalf.
| Entity Name | Moses Cone Medical Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1427095249
PECOS PAC ID: 2769395458
Enrollment ID: O20040128000519 |
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| Entity Name | The Moses H Cone Memorial Hospital Operating Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1013265909
PECOS PAC ID: 6204744600
Enrollment ID: O20121003000518 |
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| Entity Name | Virta Medical Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1093225138
PECOS PAC ID: 1355770157
Enrollment ID: O20220221001230 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Brian Mack is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Brian Mack, FNP-C
5001 Quincemoor Ct,
Greensboro, NC 27407-7789
Ph: (336) 840-8338 | Mr Brian Mack, FNP-C
655 Montgomery St Ste 810,
San Francisco, CA 94111-2677
Ph: (844) 847-8216 |
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