NPIMap

Individual provider Active NPI

Mackenzie Anne McCrorey, PA-C

  • Surgical Physician Assistant
  • Portland, OR
National Provider Identifier
1023271632
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA195380 Issued in OR
Practice address
10000 SE Main St Ste 365
Portland, OR 97216-2474
Phone
(503) 261-4430
Fax
(503) 261-4436
NPI assigned
Jul 3, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003524 IL
Surgical Physician Assistant 363AS0400X 085003524 IL
Surgical Physician Assistant 363AS0400X PA195380 OR Primary

Addresses

Primary practice location

10000 SE Main St Ste 365
Portland, OR 97216-2474

Mailing address

852 SE 59TH Ave
Portland, OR 97215-2001
Phone (312) 925-5903

Other practice location 1

1503 S State St Apt 508
Chicago, IL 60605-3414
Phone (312) 925-5903

Other identifiers 4

IdentifierTypeStateIssuer
P01216933OtherILMEDICARE RAILROAD (PROVIDER PTAN)
206147OtherILMEDICARE (GROUP PTAN)
206147235OtherILMEDICARE (INDIVIDUAL)
CA4748OtherILMEDICARE RAILROAD (GROUP PTAN)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130524000653 IL Practitioner - Physician Assistant 8426105339 Reassigns benefits to 1 organization
I20200320001476 OR Practitioner - Physician Assistant 8426105339 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
84.7
Promoting interoperability
100
Improvement activities
40
Cost
79.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Jan 19, 2013 Accepting new patients
Legacy Clinics LLC CurrentSince Feb 4, 2020 Accepting new patients
Portland Adventist Medical Center CurrentSince Jan 29, 2023 Accepting new patients
Portland Adventist Medical Center CurrentSince Jan 12, 2023 Accepting new patients

Locations

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

10151 SE Sunnyside Rd
Ste 100
Clackamas, OR 97015
Phone (503) 659-0880

14450 SE Royer Rd
Damascus, OR 97089
Phone (503) 658-5521

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

10000 SE Main St
Ste 365
Portland, OR 97216
Phone (503) 261-4430

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

501 N Graham St
Ste 220
Portland, OR 97227
Phone (503) 413-4710

Interoperability endpoints

  • Direct secure messaging: mmccrorey154649@direct.ohsu.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1023271632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 SE 59TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972152001",
            "telephone_number": "312-925-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 365",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162474",
            "telephone_number": "503-261-4430",
            "fax_number": "503-261-4436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1503 S State St Apt 508",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606053414",
            "country_code": "US",
            "telephone_number": "312-925-5903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCROREY",
        "first_name": "MACKENZIE",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-03",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003524",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085003524",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA195380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD (PROVIDER PTAN)",
            "identifier": "P01216933",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  (GROUP PTAN)",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE (INDIVIDUAL)",
            "identifier": "206147235",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD (GROUP PTAN)",
            "identifier": "CA4748",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.