Individual provider Active NPI

John J McKenna, MD

  • Family Medicine Physician
  • Madison, WI
National Provider Identifier
1174881064
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61489 Issued in WI
Practice address
1821 S Stoughton Rd
Madison, WI 53716-2257
Phone
(608) 260-6000
Fax
(608) 260-6366
NPI assigned
Apr 27, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 61489 WI Primary

Addresses

Primary practice location

1821 S Stoughton Rd
Madison, WI 53716-2257

Mailing address

1821 S Stoughton Rd
Madison, WI 53716-2257
Phone (608) 260-6000

Other identifiers 1

IdentifierTypeStateIssuer
1174881064MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmckenna261750@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20140710001849 WI Practitioner - Family Practice 5496970246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3500

103 Lake St
Deerfield, WI 53531-9455
Phone (608) 764-5487

1211 Fish Hatchery Rd
Madison, WI 53715-1909
Phone (608) 252-8000

1821 S Stoughton Rd
Madison, WI 53716-2257
Phone (608) 260-6000

225 Church St
Stoughton, WI 53589-1801
Phone (608) 877-2777

2805 Hunters TRL
Portage, WI 53901-3429
Phone (608) 745-5900

2825 Hunters TRL
Portage, WI 53901-3429
Phone (608) 742-5522

2840 Okeeffe Ave
Sun Prairie, WI 53590-7077
Phone (608) 229-8484

2850 Okeeffe Ave
Sun Prairie, WI 53590-7077
Phone (608) 282-2000

515 22ND Ave
Monroe, WI 53566-1569
Phone (608) 324-2000

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

740 Reena Ave
Fort Atkinson, WI 53538-3145
Phone (920) 563-0888

752 N High Point Rd
Madison, WI 53717-2236
Phone (608) 824-4000

753 N Main St
Oregon, WI 53575-1003
Phone (608) 835-2222

Hospital & facility affiliations

  • SSM Health at Home Home Health-Wisconsin Home health agency, Madison, WI, CCN 527184
  • Agrace Hospicecare Hospice, Madison, WI, CCN 521505
  • SSM Health at Home Hospice Hospice, Baraboo, WI, CCN 521522
  • SSM Health St Mary'S Hospital - Madison Hospital, Madison, WI, CCN 520083
  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098
  • SSM Health St Clare Hospital - Baraboo Hospital, Baraboo, WI, CCN 520057
  • Stoughton Hospital Hospital, Stoughton, WI, CCN 521343

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions34
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61489WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc. CurrentSince Jul 7, 2014 Accepting new patients
Dean Health Systems, Inc Family Medicine CurrentSince Jul 7, 2014 Accepting new patients

Locations

1821 S Stoughton Rd
Madison, WI 53716
Phone (608) 260-6000

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

Interoperability endpoints

  • Direct secure messaging: jmckenna261750@direct-ehr-ssmhc.com

Organizations & group practices 2

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 9

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": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1174881064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 S STOUGHTON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537162257",
            "telephone_number": "608-260-6000",
            "fax_number": "608-260-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 S STOUGHTON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537162257",
            "telephone_number": "608-260-6000",
            "fax_number": "608-260-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-27",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "61489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174881064",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmckenna261750@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jmckenna261750@direct-ehr-ssmhc.com",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.