Jerry Lamont McKenzie, M.D.

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

R4786 Issued in TX

Practice address

1720 E Broad St
Mansfield, TX 76063-3400

Phone

(817) 453-5912

NPI assigned

Apr 23, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Arkansas College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Strategic Medical Group TX PLLCGroup PAC ID 1355707423, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical City Arlington Hospital, Arlington, TX, CCN 450675

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Strategic Medical Group TX PLLC

  • Primary Care Clinic/Center
  • Fort Worth, TX
  • NPI 1053027680
  Medicare reassignment Care Compare group NPD
• Mansfield Medical Clinic

  • Family Medicine Physician
  • Mansfield, TX
  • NPI 1407966815
  Medicare reassignment NPD
• Theresa D. Stretch MD, PA

  • Internal Medicine Physician
  • Arlington, TX
  • NPI 1154622678
  Medicare reassignment NPD
• Ikechukwu Osuji, M.D PA

  • Medical Specialty Clinic/Center
  • Desoto, TX
  • NPI 1407994056
  NPD

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

• Columbia Medical Center of Arlington Subsidiary LP

  • General Acute Care Hospital
  • Arlington, TX
  • NPI 1134172406
  Care Compare affiliation

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1053679407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 OAK PARK LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761099534",
            "telephone_number": "817-985-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 E BROAD ST",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633400",
            "telephone_number": "817-453-5912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "845 Desco Ln",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750511685",
            "country_code": "US",
            "telephone_number": "817-761-7876",
            "fax_number": "817-635-6362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3920 W Wheatland Rd Ste 152",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752373404",
            "country_code": "US",
            "telephone_number": "214-467-0432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "JERRY",
        "middle_name": "LAMONT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-8969",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "R4786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taran Lanae McGowen, MA, LPC
• Patricia McGrew, LPC
• Slovakia McGruder
• Michael G McInnis, MD
• Landria Nicole McIntyre, WHNP
• Tamu Shamille McKinney, LCSW
• Patrick McLean, OTR, CHT
• Michelle Gay McMillan, MS, LPC
• Jamye McMillin
• MDC 14 Partners, LLC

• Geriatric Medicine (Family Medicine) Physician in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Geriatric Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.