NPIMap

Organization Active NPI

Stephen J McKenna, LLC

  • Specialist
  • Frederick, MD
National Provider Identifier
1194023374
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
D31422 Issued in MD
Legal business name
STEPHEN J MCKENNA, LLC
Practice address
187 Thomas Johnson Drive
Suite 7
Frederick, MD 21702-4503
Phone
(240) 457-4605
Fax
(240) 457-4631
NPI assigned
Mar 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Dr. Stephen J McKenna, M.D.NPI 1982665147
Title
Owner/Physician
Phone
(301) 651-0023

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X D31422 MD Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

187 Thomas Johnson Drive
Suite 7
Frederick, MD 21702-4503

Mailing address

187 Thomas Johnson Drive
Suite 7
Frederick, MD 21702-4503
Phone (240) 457-4605

Other identifiers 2

IdentifierTypeStateIssuer
483881500MedicaidMD
336913700MedicaidMD

Other names 1

  • McKenna Surgical Associates, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110321000016 MD Part B Supplier - Clinic/Group Practice 0749463370 Receives reassigned benefits from 1 practitioner
Practice locations: Frederick, MD; Silverspring, MD; Germantown, MD
O20110822000245 DC Part B Supplier - Clinic/Group Practice 0749463370 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD; Silver Spring, MD; Germantown, MD

National Provider Directory

National Provider Directory

Locations

915 Toll House Ave
Ste 303
Frederick, MD 21701
Phone (301) 698-5550

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1194023374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 THOMAS JOHNSON DRIVE",
            "address_2": "SUITE 7",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024503",
            "telephone_number": "240-457-4605",
            "fax_number": "240-457-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 THOMAS JOHNSON DRIVE",
            "address_2": "SUITE 7",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024503",
            "telephone_number": "240-457-4605",
            "fax_number": "240-457-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN J MCKENNA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-11",
        "last_updated": "2025-07-31",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "301-651-0023",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MD",
            "license": "D31422",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "483881500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336913700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKenna Surgical Associates, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.