Jill Dougal Mackinnon, M.D.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

G67976 Issued in CA

Practice address

2001 Dwight Way
2ND Floor - Room # 2350
Berkeley, CA 94704-2608

Phone

(510) 204-4738

Fax

(510) 204-5892

NPI assigned

Oct 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Vallejo, CA
  • NPI 1336222397
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1134201627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 DWIGHT WAY",
            "address_2": "2ND FLOOR - ROOM # 2350",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042608",
            "telephone_number": "510-204-4738",
            "fax_number": "510-204-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 DWIGHT WAY",
            "address_2": "2ND FLOOR - ROOM # 2350",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042608",
            "telephone_number": "510-204-4738",
            "fax_number": "510-204-5892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKINNON",
        "first_name": "JILL",
        "middle_name": "DOUGAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CA",
            "license": "G67976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "00G679760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert DS Mackay, M.D.
• Christie Mackenzie, O.D.
• Erin Cafaro Mackenzie
• Onagh Wallace Mackenzie, MD
• Stephanie Mackey
• Julia Macmillan, LM, CPM
• Megan Leah Macmillan, LMFT
• Barbra E. Macnair, L.AC.
• Marjorie M Macqueen, PA
• Mary Katherine Macvicar, M.D.

• Neuromusculoskeletal Medicine & OMM Physician in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.