Mackenzie Leigh Shattuck, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101028121 Issued in MI

Practice address

7335 Westshire Dr Ste 102
Lansing, MI 48917-9703

Phone

(517) 662-1012

Fax

(517) 622-1033

NPI assigned

Jun 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mackenzie Robson Former name

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: mackenzie.shattuck.1@25394.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/13693/brand/1/csg/1/fhir/r4
• Direct secure messaging: mackenzie.shattuck.p1@direct.ichd.nextgenshare.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.

• Msu Health Care Inc

  • Allergy & Immunology Physician
  • East Lansing, MI
  • NPI 1700418670

  MI

  Medicare reassignment NPD
• Msu Health Care Inc

  • Pediatrics Physician
  • Okemos, MI
  • NPI 1003441171

  Pediatrics

  NPD
• Msu Health Care Inc.

  • Physical Therapist
  • East Lansing, MI
  • NPI 1689206419
  NPD
• County of Ingham

  • Federally Qualified Health Center (FQHC)
  • Lansing, MI
  • NPI 1568560308
  NPD (past)
• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  NPD (past)

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1336715192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A202",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-622-1012",
            "fax_number": "517-622-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7335 WESTSHIRE DR STE 102",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489179703",
            "telephone_number": "517-662-1012",
            "fax_number": "517-622-1033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13750 S Sedona Pkwy Ste 2",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489068101",
            "country_code": "US",
            "telephone_number": "517-353-4000",
            "fax_number": "844-722-4112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4660 S Hagadorn Rd Ste 405",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488236819",
            "country_code": "US",
            "telephone_number": "517-884-8600",
            "fax_number": "517-884-8650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 W Grand River Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Okemos",
            "state": "MI",
            "postal_code": "488642394",
            "country_code": "US",
            "telephone_number": "517-349-6560",
            "fax_number": "517-349-5796",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5303 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489113800",
            "country_code": "US",
            "telephone_number": "517-887-4305",
            "fax_number": "517-887-4440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "MACKENZIE",
        "middle_name": "LEIGH",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101028121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "ROBSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary P Sharp, M.D.
• Krystel Samantha Sharpe-Kamer, D.O.
• Megan Sharrow
• Kathy Jo Shattler, RD
• Brandy Lynne Shattuck, M. D.
• Farheen Shaukat, MD
• Karlee Shave, LMSW
• Darcy Donovan Shaw, M.D.
• Jamie Marie Shay, OD
• Heidi J Sheehan, LMSW

• All providers in Lansing, MI
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.