Active NPI
John D McKenzie, MD
- Diagnostic Radiology Physician
- Jacksonville, FL
National Provider Identifier
1053371583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- ME68377
- Practice address
- 3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252 - Phone
- (904) 399-5550
- Fax
- (904) 346-4334
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | ME68377 | FL | |
| Neuroradiology Physician | 2085N0700X | ME68377 | FL | |
| Nuclear Radiology Physician | 2085N0904X | ME68377 | FL | |
| Pediatric Radiology Physician | 2085P0229X | ME68377 | FL | |
| Diagnostic Radiology Physician | 2085R0202X | ME68377 | FL | Primary |
| Vascular & Interventional Radiology Physician | 2085R0204X | ME68377 | FL | |
| Diagnostic Ultrasound Physician | 2085U0001X | ME68377 | FL |
Addresses
Primary practice location
3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252
Mailing address
3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252
Phone (904) 399-5550
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00656785A | Medicaid | GA | |
| 26933 | Other | FL | BCBS |
| 377623900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME68377 | FL | MD | Diagnostic Ultrasound Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mori Bean and Brooks Inc | Body Imaging | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268611200000",
"number": "1053371583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3599 UNIVERSITY BLVD S",
"address_2": "BUILDING 300",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164252",
"telephone_number": "904-399-5550",
"fax_number": "904-346-4334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3599 UNIVERSITY BLVD S",
"address_2": "BUILDING 300",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164252",
"telephone_number": "904-399-5550",
"fax_number": "904-346-4334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENZIE",
"first_name": "JOHN",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2010-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "FL",
"license": "ME68377",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "FL",
"license": "ME68377",
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "FL",
"license": "ME68377",
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "FL",
"license": "ME68377",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "ME68377",
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "FL",
"license": "ME68377",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "FL",
"license": "ME68377",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00656785A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "26933",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "377623900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.