Individual provider Active NPI

Makenzie Mitchell Kothmann, MD

  • Obstetrics & Gynecology Physician
  • Waco, TX
National Provider Identifier
1235793514
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
U3567 Issued in TX
Practice address
601 W Hwy 6
Waco, TX 76710-5591
Phone
(254) 772-5454
NPI assigned
Apr 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X BP10067117 TX
Obstetrics & Gynecology Physician 207V00000X U3567 TX Primary

Addresses

Primary practice location

601 W Hwy 6
Waco, TX 76710-5591

Mailing address

809 Woodland West Dr
Woodway, TX 76712-3415
Phone (325) 805-1316

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
I20231019003074 TX Practitioner - Obstetrics/Gynecology 4880929850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Texas Medical Branch at Galveston, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

301 Richland W Cir
Providence Internal Medicine Clinic
Waco, TX 76712-7932
Phone (254) 537-6200

405 Londonderry Dr
Waco, TX 76712-7921

601 W Hwy 6
Suite 106
Waco, TX 76710-5592
Phone (254) 776-7744

601 W Hwy 6 109
Fish Pond Surgery Center
Waco, TX 76710-5592
Phone (254) 751-9836

601 W State Hwy 6 101
Waco Center for Womens Health
Waco, TX 76710-5592
Phone (254) 772-5454

601 W State Hwy 6 105
Ascension Medical Group Providence Urology
Waco, TX 76710-5592
Phone (254) 741-6113

6901 Medical Pkwy
Waco, TX 76712-7910
Phone (254) 751-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10067117TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health Alliance CurrentSince Sep 1, 2023 Accepting new patients
Providence Health Alliance CurrentSince Sep 1, 2023 Accepting new patients
Ascension Providence Past Accepting new patients

Locations

601 W State Highway 6
Waco, TX 76710
Phone (254) 751-9836

405 Londonderry Dr
Ste 205
Waco, TX 76712
Phone (254) 572-8683

301 Richland West Cir
Waco, TX 76712
Phone (254) 537-6200

601 W State Highway 6
Ste 101
Waco, TX 76710
Phone (254) 772-5454

Interoperability endpoints

  • Direct secure messaging: makenzie.kothmann.1@9635.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 and National Provider Directory roles.

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": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1235793514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 WOODLAND WEST DR",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767123415",
            "telephone_number": "325-805-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W HWY 6",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105591",
            "telephone_number": "254-772-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHMANN",
        "first_name": "MAKENZIE",
        "middle_name": "MITCHELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "BP10067117",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "U3567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.