Mackenzie Robert Fountain, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101027950 Issued in MI

Practice address

18181 Oakwood Blvd Ste 401
Dearborn, MI 48124-5031

Phone

(313) 593-7240

Fax

(313) 593-8899

NPI assigned

Apr 29, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfountain4508017@direct.trinity-health.org

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.

• Advantage Health/Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1376862151
  Medicare reassignment NPD
• Advantage Health Saint Mary'S Medical Group

  • Orthopaedic Surgery Physician
  • Byron Center, MI
  • NPI 1003515008
  NPD
• Advantage Health Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1952340911
  NPD (past)
• Oakwood Healthcare Inc

  • Community/Retail Pharmacy
  • Westland, MI
  • NPI 1033128178
  NPD (past)
• Oakwood Healthcare, Inc.

  • General Acute Care Hospital
  • Dearborn, MI
  • NPI 1740230119
  NPD (past)
• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  NPD (past)

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1316520166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18181 OAKWOOD BLVD STE 401",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481245031",
            "telephone_number": "313-593-7240",
            "fax_number": "313-593-8899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7330 N Canton Center Rd Ste 216",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481871538",
            "country_code": "US",
            "telephone_number": "734-454-8001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "MACKENZIE",
        "middle_name": "ROBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-29",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101027950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.