Jenna M McKenzie, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

340249 Issued in NY

Practice address

640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324

Phone

(631) 737-0100

Fax

(631) 471-1117

NPI assigned

Jul 19, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantagecare Physicians PCGroup PAC ID 2365735008, 307 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Interoperability endpoints

• Direct secure messaging: jenna.nelson@chn.eclinicaldirectplus.com
• FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4
• Direct secure messaging: jmckenzie26684@direct.acpny.com

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.

• Advantagecare Physicians PC

  • General Practice Physician
  • New York, NY
  • NPI 1336578772
  Medicare reassignment Care Compare group NPD
• Advantagecare Physicians PC

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1063954113
  NPD

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

{
    "created_epoch": "1437264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1225412208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER STREET",
            "address_2": "2ND FLOOR CRED DEPT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410004",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HAWKINS AVE",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-737-0100",
            "fax_number": "631-471-1117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1991 Marcus Ave",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "11042",
            "country_code": "US",
            "telephone_number": "516-354-1600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Bayshore Road",
            "address_purpose": "LOCATION",
            "city": "North Babylon",
            "state": "NY",
            "postal_code": "117032823",
            "country_code": "US",
            "telephone_number": "631-586-2700",
            "fax_number": "631-491-8613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "JENNA",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-19",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "661769",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "340249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695941",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Frederick Mazzeo, MD
• Fiona McBreen, LMSW
• Kerrin Maureen McBreen, CCC-SLP
• Michael James McGovern, O.D.
• Meagan McGuigan, L.P.N.
• Nicole McLaughlin
• Medi Active Wheels LLC
• Medical Group Pharmacy Inc
• Mitchell Elliott Mehlman
• Melody a Espiritu Physical Therapist PC

• Family Nurse Practitioner in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.