NPIMap

Individual provider Active NPI

Tristan Joseph McKenna, DO

  • Family Medicine Physician
  • Ankeny, IA
National Provider Identifier
1417304403
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO-05812 Issued in IA
Practice address
2605 SW White Birch Dr
Ankeny, IA 50023-7204
Phone
(515) 643-7100
Fax
(515) 643-7145
NPI assigned
May 19, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X DO-05812 IA Primary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X DO-05812 IA

Addresses

Primary practice location

2605 SW White Birch Dr
Ankeny, IA 50023-7204

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-7100

Other practice location 1

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-2101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20210730000574 IA Practitioner - Family Practice 0143659797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Arizona College of Osteopathic Medicine Mid Western University, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

2605 SW White Birch Dr
Mercyone Ankeny Prairie Trail Family Medici
Ankeny, IA 50023-7235
Phone (515) 643-7100

2605 SW White Birch Dr
Mercyone S Des Moines Behavioral Health Car
Ankeny, IA 50023-7204
Phone (515) 643-8350

330 Laurel St
Suite 1200
Des Moines, IA 50314-3044
Phone (515) 643-6290

800 E 1St St
Ankeny, IA 50021-2077

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Mercy Clinics, Inc. Family Medicine Current Accepting new patients
Mercy Clinics, Inc Family Medicine CurrentSince Aug 1, 2021 Accepting new patients

Locations

2605 SW White Birch Dr
Ankeny, IA 50023
Phone (515) 643-7100

330 Laurel St
Ste 1200
Des Moines, IA 50314
Phone (515) 643-5454

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

1601 NW 114th St
Ste 247
Des Moines, IA 50325
Phone (515) 222-7000

5900 E University Ave
Ste 100
Pleasant Hill, IA 50327
Phone (515) 643-2400

Interoperability endpoints

  • Direct secure messaging: tmckenna3952140@direct.trinity-health.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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": "1463616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1417304403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-7100",
            "fax_number": "515-643-7145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 SW WHITE BIRCH DR",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237204",
            "telephone_number": "515-643-7100",
            "fax_number": "515-643-7145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3269 N Stockton Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "86409",
            "country_code": "US",
            "telephone_number": "928-757-2101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "TRISTAN",
        "middle_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-19",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-05812",
            "primary": true
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IA",
            "license": "DO-05812",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.