Jeffrey K McKenna, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

036.118958 Issued in IL

Practice address

100 Deerpath
Charleston, IL 61920-9427

Phone

(217) 234-8000

Fax

(217) 234-8003

NPI assigned

Mar 10, 2006

Last updated

Aug 5, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

University of Vermont College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology and Mohs Surgery Institute LTDGroup PAC ID 3870732191, 7 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmckenna@dermandmohs.emadirect.md

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.

• Dermatology and Mohs Surgery Institute, LTD.

  • Specialist
  • Bloomington, IL
  • NPI 1770828626
  Medicare reassignment Care Compare group NPD Authorized official
• Carle Bromenn Medical Center

  dba Advocate BroMenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  NPD (past)
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Leonard Dzubow MD PC

  • MOHS-Micrographic Surgery Physician
  • Media, PA
  • NPI 1568417467
  NPD (past)
• The Huntington Medical Foundation

  dba Huntington Health Physicians

  • Internal Medicine Physician
  • Pasadena, CA
  • NPI 1154467181

  Dermatology

  NPD (past)
• The Huntington Medical Foundation

  • Internal Medicine Physician
  • Pasadena, CA
  • NPI 1639225048
  NPD (past)
• U-U Pediatric Dermatology

  • Pediatric Dermatology Physician
  • Salt Lake City, UT
  • NPI 1235339193
  NPD (past)

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1396713780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 E EMPIRE ST",
            "address_2": "SECOND FLOOR STE E & F",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617045402",
            "telephone_number": "309-451-3376",
            "fax_number": "309-452-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DEERPATH",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619209427",
            "telephone_number": "217-234-8000",
            "fax_number": "217-234-8003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 S 13th St",
            "address_purpose": "LOCATION",
            "city": "Pekin",
            "state": "IL",
            "postal_code": "615544936",
            "country_code": "US",
            "telephone_number": "309-693-7788",
            "fax_number": "309-452-3376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4909 N Glen Park Place Rd",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616144676",
            "country_code": "US",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-0500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 West St Ste 212",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IL",
            "postal_code": "613542769",
            "country_code": "US",
            "telephone_number": "815-842-4000",
            "fax_number": "815-223-8736",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 Park Ave E Ste 204",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "613563902",
            "country_code": "US",
            "telephone_number": "815-842-4000",
            "fax_number": "309-452-3376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3024 E Empire St Ste Eandf",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617045402",
            "country_code": "US",
            "telephone_number": "309-451-3376",
            "fax_number": "309-452-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JEFFREY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-118958",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036.118958",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036-118958",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn McBride
• Lisa A McDaniel
• Annmarie S McDonagh, MD
• Raeley McGlothan, PHARMD
• Heidi J McKean, ATC
• James William McNally, MD
• Leland E. McNeill, M.D.
• Linda McPhee
• Jamieson Miller
• Marcie Kurth Miller, M.A., CCC SLP

• MOHS-Micrographic Surgery Physician in Charleston, IL
• Providers in Charleston, IL by specialty
• MOHS-Micrographic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.