Individual provider Active NPI

John M McKenna, MD

  • Pulmonary Disease Physician
  • Midland, TX
National Provider Identifier
1225170103
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
E-4516 Issued in TX
Practice address
400 Rosalind Redfern Grover Pkwy Ste 271
Midland, TX 79701-5857
Phone
(432) 221-2700
Fax
(432) 221-2702
NPI assigned
Feb 13, 2007
Last updated
May 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X E-4516 TX Primary

Addresses

Primary practice location

400 Rosalind Redfern Grover Pkwy Ste 271
Midland, TX 79701-5857

Mailing address

4214 Andrews Hwy Ste 240
Midland, TX 79703-4817
Phone (432) 685-0633

Other identifiers 1

IdentifierTypeStateIssuer
1103996-02MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JOHN.MCKENNA.1@3522.DIRECT.ATHENAHEALTH.COM Direct

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
I20070905000757 TX Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 2264525351 Reassigns benefits to 1 organization
Practice locations: Midland, TX

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
University of Texas Southwestern Medical School at Dallas, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Family Care I IncGroup PAC ID 2567351372, 71 clinicians

Practice addresses (Care Compare)

400 Rosalind Redfern Grover Pkwy
Suite 271
Midland, TX 79701-5857
Phone (432) 686-6605

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4516TXMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Family Care I, Inc CurrentSince Dec 1, 2021 Accepting new patients
Sirius Health Solutions LLC Past Accepting new patients
Premier Physicians Past Accepting new patients

Locations

400 Rosalind Redfern Grover Pkwy
Ste 271
Midland, TX 79701
Phone (432) 221-2700

4214 Andrews Hwy
Ste 240
Midland, TX 79703
Phone (432) 686-6605

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18292/brand/1/csg/1/fhir/r4
  • Direct secure messaging: john.mckenna.1@3522.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1225170103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4214 ANDREWS HWY STE 240",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797034817",
            "telephone_number": "432-685-0633",
            "fax_number": "432-685-1043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROSALIND REDFERN GROVER PKWY STE 271",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015857",
            "telephone_number": "432-221-2700",
            "fax_number": "432-221-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "E-4516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1103996-02",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JOHN.MCKENNA.1@3522.DIRECT.ATHENAHEALTH.COM",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "400 Rosalind Redfern Grover Pkwy Ste 271",
            "city": "Midland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "797015857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

Verify at the official NPI Registry.