Clark R McKenzie, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

R4P62 Issued in MO

Practice address

450 N New Ballas Rd
Ste 270 W
Saint Louis, MO 63195-2632

Phone

(314) 991-6969

Fax

(314) 997-6969

NPI assigned

Aug 25, 2005

Last updated

Jan 19, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in MO

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

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Nephrology

Education

University of Missouri, Kansas City, School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heart Care Specialists LLCGroup PAC ID 2062774755, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059
• Sparta Community Hospital Hospital, Sparta, IL, CCN 141349

Merit-based Incentive Payment System (MIPS)

Final score

92.71 of 100Reported as apm

Quality

82.25

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heart Care Specialists, LLC

  • Medical Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1275031866

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Cardiothoracic Surgery, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Chesterfield, MO
  • NPI 1104895812
  NPD (past)
• Mercy Clinic Cardiovascular and Thoracic Surgery, LLC

  • Vascular Surgery Physician
  • Washington, MO
  • NPI 1528192416
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)
• The Heart Health Center Cath Lab, LLC

  dba The Heart Health Center Cath Lab

  • Cardiovascular Disease Physician
  • Saint Louis, MO
  • NPI 1124011010
  NPD (past)
• The Heart Health Center, PC

  dba The Heart Health Center

  • Cardiovascular Disease Physician
  • Saint Louis, MO
  • NPI 1801889795
  NPD (past)
• The Heart Health Center, PC

  • Cardiovascular Disease Physician
  • Farmington, MO
  • NPI 1881863009
  NPD (past)

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

• St. Lukes Episcopal-Presbyterian Hospital

  dba St. Luke's Hospital

  • General Acute Care Hospital
  • Chesterfield, MO
  • NPI 1346251543
  Care Compare affiliation
• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation
• Sparta Community Hospital

  • Critical Access Hospital
  • Sparta, IL
  • NPI 1548216476
  Care Compare affiliation

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1073506051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 N NEW BALLAS RD",
            "address_2": "STE 270 W",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631952632",
            "telephone_number": "314-991-6969",
            "fax_number": "314-997-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N NEW BALLAS RD",
            "address_2": "STE 270 W",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631952632",
            "telephone_number": "314-991-6969",
            "fax_number": "314-997-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "CLARK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R4P62",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "R4P62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE CCL GROUP NUMBER",
            "identifier": "000047049",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROV ID AREA 99",
            "identifier": "004013185",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP 01",
            "identifier": "CD6536",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER ID",
            "identifier": "006012762",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCL GROUP NUMBER",
            "identifier": "MA1080",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR CCL GROUP",
            "identifier": "P00275849",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "110171721",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HHC CATH GROUP NPI",
            "identifier": "1124011010",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STL GROUP NPI",
            "identifier": "1801889795",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP 99",
            "identifier": "CI7050",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FARM GROUP NPI",
            "identifier": "1881863009",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCL INDIVDUAL PROV NUMBER",
            "identifier": "MA1080001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia F McKelvy, M.D.
• Adria Marie McKenna
• Becky Mulvihill McKenna, PH.D.
• Brian T McKenna, M.D.
• Melissa L McKenna, LPC
• Kerry Alicia McKenzie, NURSE PRACTITIONER
• Laura Beth McKenzie, DO
• Patricia Flynn McKenzie, B.C, A.N.P.
• Phoelica McKenzie, LCSW
• Vivienne McKenzie

• Interventional Cardiology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Interventional Cardiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.