Glen Carlisle Mackenzie, MD

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

0420009174 Issued in VT

Practice address

1009 Depot St
Manchester Center, VT 05255-9731

Phone

(802) 442-8649

Fax

(802) 442-8658

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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 VT

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

Specialty

Obstetrics/Gynecology

Education

Loyola University of Chicago, Stritch School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005
• Southwestern Vermont Medical Center Hospital, Bennington, VT, CCN 470012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Glen Mackenzie MD PC

  • Gynecology Physician
  • Manchester Center, VT
  • NPI 1467806067
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Rutland Hospital, Inc.

  • General Acute Care Hospital
  • Rutland, VT
  • NPI 1720042203
  Care Compare affiliation
• Southwestern Vermont Medical Center Inc.

  • General Acute Care Hospital
  • Bennington, VT
  • NPI 1205865789
  Care Compare affiliation

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1306926704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 DEPOT ST",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052559731",
            "telephone_number": "802-442-8649",
            "fax_number": "802-442-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 DEPOT ST",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052559731",
            "telephone_number": "802-442-8649",
            "fax_number": "802-442-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "GLEN",
        "middle_name": "CARLISLE",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VT",
            "license": "0420009174",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "VT",
            "license": "0420009174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN1210",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lesley Brodie, M.D., P.C.
• Carol A Loeffler, PHD
• Leigh S Lopresti, MD
• Katherine J Lowkes, AU.D.
• Mulu Yacouba Lubula, PHARMD, MBA, MS
• Christie J Mackson, APRN
• Katherine Maclauchlan
• Dakota Malik, ND
• Richard Malik, N.D.
• Manchester Dental Group PLC

• Gynecology Physician in Manchester Center, VT
• Providers in Manchester Center, VT by specialty
• Gynecology Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; 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.