NPIMap

Individual provider Active NPI

McKenzie B Tucker, DO

  • Family Medicine Physician
  • Henderson, KY
National Provider Identifier
1215596036
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11020485A Issued in IN
Practice address
1413 N Elm St Ste 201
Henderson, KY 42420-2767
Phone
(270) 827-8662
Fax
(270) 826-8220
NPI assigned
Jun 6, 2019
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11020485A IN Primary
Family Medicine Physician 207Q00000X 05137 KY

Addresses

Primary practice location

1413 N Elm St Ste 201
Henderson, KY 42420-2767

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815

Other names 1

  • McKenzie B Schaefer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221021002632 KY Practitioner - Family Practice 0547595779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

1413 N Elm St
Suite 201
Henderson, KY 42420-2767
Phone (270) 827-8662

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11020485AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc Family Medicine CurrentSince Oct 31, 2022 Accepting new patients
Deaconess Clinic, Inc Family Medicine Current Accepting new patients
Deaconess Clinic, Inc Family Medicine CurrentSince Oct 31, 2022 Accepting new patients
Deaconess Hospital, Inc. Family Medicine Past Accepting new patients
Deaconess Clinic, Inc Family Medicine Past Accepting new patients

Locations

1413 N Elm St
Ste 201
Henderson, KY 42420
Phone (270) 827-8662

1700 US Highway 60 W
Morganfield, KY 42437
Phone (270) 389-0031

Interoperability endpoints

  • Direct secure messaging: mschaefer203053@direct.deaconess.com

Organizations & group practices 5

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 8

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": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1215596036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 N ELM ST STE 201",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202767",
            "telephone_number": "270-827-8662",
            "fax_number": "270-826-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "MCKENZIE",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11020485A",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "05137",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENZIE",
            "last_name": "SCHAEFER",
            "middle_name": "B",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Henderson, KY

Sources for this page

Verify at the official NPI Registry.