NPIMap

Individual provider Active NPI

Mackenzie R Tiderington, P.A-C

  • Physician Assistant
  • Dayton, OH
National Provider Identifier
1114577103
Registry record updated Dec 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.006159RX Issued in OH
Practice address
4160 Little York Rd Ste 10
Dayton, OH 45414-5803
Phone
(937) 415-9100
Fax
(937) 415-9191
NPI assigned
Sep 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.006159RX OH Primary

Addresses

Primary practice location

4160 Little York Rd Ste 10
Dayton, OH 45414-5803

Mailing address

6551 Centerville Business Pkwy Ste 120
Centerville, OH 45459-2696
Phone (937) 415-9100

Other identifiers 1

IdentifierTypeStateIssuer
50.006159RXOtherOHOH MEDICAL LICENSE

Other names 1

  • Mackenzie R Rice Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191125001735 OH Practitioner - Physician Assistant 5698108090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Associates of SW Ohio IncGroup PAC ID 9638258874, 59 clinicians

Practice addresses (Care Compare)

1002 Rainbow CT
Fairborn, OH 45324-6365
Phone (800) 824-9861

4160 Little York Rd
Suite 10
Dayton, OH 45414-5803
Phone (937) 415-9100

7677 Yankee St
Suite 110
Centerville, OH 45459-3475
Phone (937) 428-0400

Hospital & facility affiliations

  • Buckeye Home Health Care, LLC Home health agency, Dayton, OH, CCN 368197
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Wilson Memorial Hospital Hospital, Sidney, OH, CCN 360013
  • Upper Valley Medical Center Hospital, Troy, OH, CCN 360174
  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Wayne Hospital Hospital, Greenville, OH, CCN 361335

Merit-based Incentive Payment System (MIPS)

Final score
83.43 of 100Reported as group
Quality
70.97
Promoting interoperability
98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Susan Murphy Current Accepting new patients
Orthopedic Associates of SW Ohio, Inc CurrentSince Oct 1, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

6551 Centerville Business Pkwy
Ste 120
Dayton, OH 45459
Phone (937) 428-0400

4160 Little York Rd
Ste 10
Dayton, OH 45414
Phone 9374159100335

7677 Yankee St
Ste 110
Dayton, OH 45459
Phone (937) 401-6400

1002 Rainbow Ct
Fairborn, OH 45324

6438 Wilmington Pike
Ste 110
Sugarcreek Township, OH 45459
Phone (937) 848-4121

Organizations & group practices 3

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 6

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": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670112000000",
    "number": "1114577103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6551 CENTERVILLE BUSINESS PKWY STE 120",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592696",
            "telephone_number": "937-415-9100",
            "fax_number": "937-415-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 LITTLE YORK RD STE 10",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454145803",
            "telephone_number": "937-415-9100",
            "fax_number": "937-415-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDERINGTON",
        "first_name": "MACKENZIE",
        "middle_name": "R",
        "credential": "P.A-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-12",
        "last_updated": "2022-12-04",
        "certification_date": "2022-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006159RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH MEDICAL LICENSE",
            "identifier": "50.006159RX",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "RICE",
            "middle_name": "R",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.