NPIMap

Individual provider Active NPI

Jennifer C McKenna, MD

  • Obstetrics & Gynecology Physician
  • Carrollton, GA
National Provider Identifier
1346328275
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD18326 Issued in ME
Practice address
109 Professional PL
Carrollton, GA 30117-3862
Phone
(770) 834-0170
Fax
(770) 214-1546
NPI assigned
Nov 1, 2006
Last updated
Feb 17, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD18326 ME Primary

Addresses

Primary practice location

109 Professional PL
Carrollton, GA 30117-3862

Mailing address

3 Glen Cove Dr
Ste 1
Rockport, ME 04856-4232
Phone (770) 834-0170

Other identifiers 5

IdentifierTypeStateIssuer
332133OtherGAWELLCARE
000797288CMedicaidGA
000797288COtherGAPEACH STATE
002047OtherGABLUE CROSS BLUE SHIELD
581456616OtherGATAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20100716000741 ME Practitioner - Obstetrics/Gynecology 1355240987 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, shared by 31 NPIs, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

3 Glen Cove Dr
Rockport, ME 04856-4232

6 Glen Cove Dr
Rockport, ME 04856-4272
Phone (207) 921-8969

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD18326MEMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Penobscot Bay Physicians & Associates CurrentSince May 31, 2010 Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Apr 1, 2015 Accepting new patients
Preferred Women's Healthcare, LLC Past Accepting new patients
Mainehealth Past Accepting new patients
Mainehealth Past Accepting new patients

Locations

116 Northport Ave
Ste 220
Belfast, ME 04915
Phone (207) 505-4015

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

3 Glen Cove Dr
#1
Rockport, ME 04856
Phone (207) 301-8900

3 Glen Cove Dr
#3
Rockport, ME 04856
Phone (207) 301-5400

4 Glen Cove Dr
Ste 5
Rockport, ME 04856
Phone (207) 593-5883

6 Glen Cove Dr
Rockport, ME 04856
Phone (207) 596-8000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7139/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jmckenna10484@direct.mmc.mainehealth.org

Organizations & group practices 8

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 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1346328275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 GLEN COVE DR",
            "address_2": "STE 1",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564232",
            "telephone_number": "770-834-0170",
            "fax_number": "770-214-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 PROFESSIONAL PL",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173862",
            "telephone_number": "770-834-0170",
            "fax_number": "770-214-1546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ME",
            "license": "MD18326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "332133",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000797288C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE",
            "identifier": "000797288C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "002047",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "581456616",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.