McKenzie R Youngblood, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085008385 Issued in IL

Practice address

4 Memorial Dr Ste 130
Alton, IL 62002-6704

Phone

(618) 463-7600

NPI assigned

Oct 13, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059
• Alton Memorial Hospital Hospital, Alton, IL, CCN 140002
• Osf Saint Anthony'S Health Center Hospital, Alton, IL, CCN 140052

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment Care Compare group NPD

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

• Alton Memorial Hospital

  • Ambulance
  • Alton, IL
  • NPI 1063669117

  Hospital

  Care Compare affiliation
• Alton Memorial Hospital

  • General Acute Care Hospital
  • Alton, IL
  • NPI 1548278476
  Care Compare affiliation
• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation
• Osf Healthcare System

  • General Acute Care Hospital
  • Alton, IL
  • NPI 1710396932
  Care Compare affiliation

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1063010924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 130",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704",
            "telephone_number": "618-463-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 130",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704",
            "telephone_number": "618-463-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "MCKENZIE",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085008385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mckenzie_youngblood1@mytennova.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "6059 Arbury Way Ste 101",
            "city": "Ooltewah",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373635001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mckenzie.youngblood.1@1525.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "6059 Arbury Way Ste 101",
            "city": "Ooltewah",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373635001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4 Memorial Dr Ste 130",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mickey Jean Young, RN
• Rosalind Young
• Susan Elizabeth Young, P.T.
• Vicki K Young, FNP
• James L Youngblood, RPH
• Nicholas Andrew Yuhas, DMD
• John L Zabrowski, M.D.
• Alexa Zampieri, BA
• Jason Zarantonello
• Steven P Zenker, MD

• Physician Assistant in Alton, IL
• Providers in Alton, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.