Individual provider Active NPI

Mackenzie Wehner, M.D.

  • Dermatology Physician
  • Houston, TX
National Provider Identifier
1134531221
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
S3338 Issued in TX
Practice address
1515 Holcombe Blvd
Houston, TX 77030-4009
Phone
(713) 792-6161
NPI assigned
May 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD464686 PA
Procedural Dermatology Physician 207NS0135X MD464686 PA
Dermatology Physician 207N00000X S3338 TX Primary

Addresses

Primary practice location

1515 Holcombe Blvd
Houston, TX 77030-4009

Mailing address

PO Box 4439
Houston, TX 77210-4439
Phone (713) 792-2991

Other practice location 1

3400 Spruce St
Philadelphia, PA 19104
Phone (215) 662-2737

Other identifiers 3

IdentifierTypeStateIssuer
404224402OtherTXMEDICAID-CSHCN
8LW238OtherTXBCBS
404224401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20191113002270 TX Practitioner - Dermatology 9830489376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Stanford University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Referral ServiceGroup PAC ID 7911801410, 2,728 clinicians

Practice addresses (Care Compare)

1515 Holcombe Blvd
Houston, TX 77030-4000
Phone (713) 792-2121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.29 of 100Reported as group
Quality
70.82
Promoting interoperability
100
Improvement activities
40
Cost
67.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions170
Skin biopsy21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD464686PAMDDermatology Physician
S3338TXMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2018 Accepting new patients
Physicians Referral Service CurrentSince Oct 8, 2019 Accepting new patients

Locations

3400 Civic Center Blvd
Ste 1-330S
Philadelphia, PA 19104
Phone (215) 360-0909

1515 Holcombe Blvd
Houston, TX 77030
Phone (713) 794-5446

1515 Holcombe Blvd
#R4212
Houston, TX 77030
Phone (713) 794-5446

1515 Holcombe Blvd
#M
Houston, TX 77030
Phone (713) 792-6127

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 1

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": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1134531221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4439",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104439",
            "telephone_number": "713-792-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304009",
            "telephone_number": "713-792-6161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-662-2737",
            "fax_number": "215-349-8339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEHNER",
        "first_name": "MACKENZIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD464686",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "PA",
            "license": "MD464686",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "S3338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID-CSHCN",
            "identifier": "404224402",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LW238",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404224401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.