Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Side Mitchell Mack Jr., PA

Individual provider Physician Assistant · NPI 1740232966

Side Mitchell Mack Jr., PA is a Physician Assistant in Greensboro, North Carolina. Qualified in 2005, 21 years ago. Practices with Carolina Medicorp Enterprises LLC, a 185-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
21
Licensed in
NC
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1309 Lees Chapel Rd
Greensboro, NC 27455-2601
Phone: (336) 286-5505
Fax: (336) 288-2900
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1200 N Elm St, Greensboro, NC 27401-1004 — (336) 716-2255
  • 794 S Main St Ste B, Kernersville, NC 27284-4074 — (336) 904-2317

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-00323 (NC)
Physician Assistant Taxonomy 363A00000X · Licence 1000323 (NC)

Record details

NPI number1740232966
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 16, 2006
Last updated in NPPESFebruary 1, 2022
Certification dateFebruary 1, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Carolina Medicorp Enterprises Llc — 185 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients99
Services billed 167 a service is one billed item, such as a visit, a test or a procedure
Average patient age72

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Colleagues at Carolina Medicorp Enterprises LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 185 clinicians in the practice; 12 are shown here.

Other providers in Greensboro