Individual provider Active NPI

Mackenzie Bartlett, M.D.

  • Pediatrics Physician
  • Manchester, NH
National Provider Identifier
1396123790
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18779 Issued in NH
Practice address
1 Elliot Way
Manchester, NH 03103
Phone
(603) 663-2710
NPI assigned
May 18, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LP03443 RI
Pediatrics Physician 208000000X 18779 NH Primary

Addresses

Primary practice location

1 Elliot Way
Manchester, NH 03103

Mailing address

1 Elliot Way
Manchester, NH 03103-3502
Phone (603) 663-2710

Other practice location 1

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4471

Other practice location 2

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20180904002762 NH Practitioner - Pediatric MedicinePractitioner - Hospitalist 6305196809 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18779NHMDPediatrics Physician
LP03443RIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elliot Professional Services CurrentSince Sep 1, 2018 Accepting new patients
Elliot Hospital of the City of Manchester Past Accepting new patients

Locations

275 Mammoth Rd
Ste 1
Manchester, NH 03109
Phone (603) 663-3222

1 Elliot Way
Manchester, NH 03103
Phone (603) 663-2271

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1396123790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033502",
            "telephone_number": "603-663-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "03103",
            "telephone_number": "603-663-2710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-4471",
            "fax_number": "401-444-7574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-4471",
            "fax_number": "401-444-7574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARTLETT",
        "first_name": "MACKENZIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "LP03443",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NH",
            "license": "18779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.