NPIMap

Individual provider Active NPI

Diane Mackenzie, DO

  • Emergency Medicine Physician
  • Newark, NJ
National Provider Identifier
1316931264
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25MB07665200 Issued in NJ
Practice address
495 N 13TH St
Newark, NJ 07107-1317
Phone
(973) 268-1400
NPI assigned
Sep 7, 2005
Last updated
May 7, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 25MB07665200 NJ Primary
General Practice Physician 208D00000X 25MB07665200 NJ

Addresses

Primary practice location

495 N 13TH St
Newark, NJ 07107-1317

Mailing address

66 West Gilbert Street
Red Bank, NJ 07701-4918
Phone (732) 212-0060

Other identifiers 1

IdentifierTypeStateIssuer
0023361MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040524000217 NJ Practitioner - Internal MedicinePractitioner - Emergency Medicine 6901897339 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Rowan University School of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
VPS Medical Services, PCGroup PAC ID 2961836069, 45 clinicians

Practice addresses (Care Compare)

3600 State Route 66
Neptune, NJ 07753-2645

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
VPS Medical Services, PC CurrentSince Jan 1, 2020 Accepting new patients
Visiting Nurse Association of Central Jersey, Inc. CurrentSince Aug 1, 2016 Accepting new patients
Essex Emergency Associates, P.a. Emergency Medicine Past Accepting new patients
Emergency Physician Associates of South Jersey P C Emergency Medicine Past Accepting new patients
Emergency Associates of the North Ward, P.a. Emergency Medicine Past Accepting new patients
Emergency Medical Consultants of South Jersey LLC Past Accepting new patients

Locations

23 Main St
#D1
Holmdel, NJ 07733
Phone (732) 224-6914

1100 Wayside Rd
Tinton Falls, NJ 07712
Phone (732) 493-2220

3600 State Route 66
Fl 4
Tinton Falls, NJ 07753
Phone (732) 241-4194

Interoperability endpoints

  • Direct secure messaging: dr.mackenzie.p2@direct.vnahg.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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 6

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": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210118400000",
    "number": "1316931264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WEST GILBERT STREET",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077014918",
            "telephone_number": "732-212-0060",
            "fax_number": "732-212-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 N 13TH ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071071317",
            "telephone_number": "973-268-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2008-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB07665200",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NJ",
            "license": "25MB07665200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0023361",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.