Individual provider Active NPI

Kyle Jospeh Mackin, M.D.

  • Surgery Physician
  • Rogers, AR
National Provider Identifier
1053755637
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
E12328 Issued in AR
Practice address
1001 S Horsebarn Rd
Rogers, AR 72758
Phone
(479) 273-7700
Fax
(479) 464-7734
NPI assigned
Apr 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X E12328 AR Primary

Addresses

Primary practice location

1001 S Horsebarn Rd
Rogers, AR 72758

Mailing address

1001 S Horsebarn Rd
Rogers, AR 72758-8184
Phone (479) 273-7700

Other practice location 1

4502 E 41st St
Tulsa, OK 74135-2536
Phone (918) 408-6088

Other practice location 2

4502 E 41st St
Tulsa, OK 74135-2536
Phone (918) 408-6088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20190610002500 AR Practitioner - General Surgery 2466774674 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Northwest Arkansas CommunitiesGroup PAC ID 0648177873, shared by 5 NPIs, 314 clinicians

Practice addresses (Care Compare)

1001 S Horsebarn Rd
Rogers, AR 72758-8184
Phone (479) 273-7700

2710 S Rife Medical LN
Rogers, AR 72758-1452
Phone (479) 338-8000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E12328ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities CurrentSince Jun 5, 2019 Accepting new patients
Mercy Health Northwest Arkansas Communities Surgery CurrentSince Jun 5, 2019 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jun 5, 2019 Accepting new patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Dec 24, 2020 Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

2708 S Rife Medical Ln
Ste T30
Rogers, AR 72758
Phone (479) 338-3999

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 338-8000

1001 S Horsebarn Rd
Rogers, AR 72758
Phone (479) 273-7700

Interoperability endpoints

  • Direct secure messaging: kmackin1031156@directc.mercy.net

Organizations & group practices 5

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 3

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": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1053755637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S HORSEBARN RD",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588184",
            "telephone_number": "479-273-7700",
            "fax_number": "479-464-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S HORSEBARN RD",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "72758",
            "telephone_number": "479-273-7700",
            "fax_number": "479-464-7734"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 E 41st St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741352536",
            "country_code": "US",
            "telephone_number": "918-408-6088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4502 E 41st St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741352536",
            "country_code": "US",
            "telephone_number": "918-408-6088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKIN",
        "first_name": "KYLE",
        "middle_name": "JOSPEH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-25",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E12328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

Verify at the official NPI Registry.