Individual provider Active NPI

McKenzie Madill, PA-C

  • Physician Assistant
  • Fort Smith, AR
National Provider Identifier
1508477563
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1306 Issued in AR
Practice address
6801 Phoenix Ave Ste 1
Fort Smith, AR 72903-5299
Phone
(479) 384-5378
NPI assigned
Aug 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1306 AR Primary

Addresses

Primary practice location

6801 Phoenix Ave Ste 1
Fort Smith, AR 72903-5299

Mailing address

6801 Phoenix Ave Ste 1
Fort Smith, AR 72903-5299
Phone (479) 384-5378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220725003336 TX Practitioner - Physician Assistant 2860873601 Reassigns benefits to 1 organization
I20241023004663 AR Practitioner - Physician Assistant 2860873601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Northwest Arkansas Ambulatory Services, LLCGroup PAC ID 3779827993, 50 clinicians

Practice addresses (Care Compare)

2012 S Promenade Blvd
Rogers, AR 72758-9073
Phone (479) 616-1485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Nov 1, 2023 Accepting new patients
Texas Health Physicians Group CurrentSince Nov 1, 2023 Accepting new patients
Stella Mattina Primary Care Inc PastSince Nov 10, 2024 Accepting new patients
Mercy Health Northwest Arkansas Communities Past Accepting new patients

Locations

2730 SW Wilshire Blvd
Burleson, TX 76028
Phone (817) 916-5180

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

Organizations & group practices 6

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": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1508477563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 PHOENIX AVE STE 1",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035299",
            "telephone_number": "479-384-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 PHOENIX AVE STE 1",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035299",
            "telephone_number": "479-384-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADILL",
        "first_name": "MCKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-1306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.