Individual provider Active NPI

Mackenzie Meyer Berrus, PA-C

  • Physician Assistant
  • Albany, NY
National Provider Identifier
1144792904
Registry record updated Dec 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022817 Issued in NY
Practice address
920 Lark Dr
Albany, NY 12207-1398
Phone
(518) 465-4771
NPI assigned
Dec 18, 2018
Last updated
Dec 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2018

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 022817 NY Primary

Addresses

Primary practice location

920 Lark Dr
Albany, NY 12207-1398

Mailing address

920 Lark Dr
Albany, NY 12207-1398
Phone (518) 465-4771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20190115001681 NY Practitioner - Physician Assistant 4486990207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Twin Rivers Medical PCGroup PAC ID 6406123405, 17 clinicians

Practice addresses (Care Compare)

16 Danforth St
Hoosick Falls, NY 12090-1226
Phone (518) 686-5770

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022817NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Rivers Medical PC CurrentSince Feb 1, 2023 Accepting new patients

Locations

16 Danforth St
Hoosick Falls, NY 12090
Phone (518) 686-5002

100 Hospital Dr
#44
Bennington, VT 05201
Phone (802) 442-4509

Interoperability endpoints

  • Direct secure messaging: mackenzie.berrus.1@3744.direct.athenahealth.com

Organizations & group practices 1

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.

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": "1545091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545091200000",
    "number": "1144792904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071398",
            "telephone_number": "518-465-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071398",
            "telephone_number": "518-465-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRUS",
        "first_name": "MACKENZIE",
        "middle_name": "MEYER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-18",
        "last_updated": "2018-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.