NPIMap

Individual provider Active NPI

Michelle McKenney

  • Obesity Medicine (Preventive Medicine) Physician
  • Wareham, MA
National Provider Identifier
1518176320
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Preventive Medicine) PhysicianTaxonomy code 2083B0002X
License
253800 Issued in MA
Practice address
100 Rosebrook Way
Wareham, MA 02571-1138
Phone
(508) 273-4901
Fax
(508) 973-4907
NPI assigned
May 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 253800 MA
Obesity Medicine (Preventive Medicine) Physician 2083B0002X 253800 MA Primary

Addresses

Primary practice location

100 Rosebrook Way
Wareham, MA 02571-1138

Mailing address

200 Mill Rd Ste 180
Fairhaven, MA 02719-5255
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
110095467AMedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmckenney40534@direct.southcoast.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20130404000338 MA Practitioner - Family Practice 4587809066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

500 Faunce Corner Rd
North Dartmouth, MA 02747-1278
Phone (508) 973-2216

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
253800MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prima Care, PC CurrentSince May 12, 2025 Accepting new patients
Southcoast Physicians Group, Inc. Family Medicine CurrentSince Aug 5, 2017 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Aug 5, 2017 Accepting new patients
Prima Care, PC CurrentSince May 12, 2025 Accepting new patients

Locations

208 Mill Rd
Fairhaven, MA 02719
Phone (508) 758-3781

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

851 Middle St
Ste 2100
Fall River, MA 02721
Phone (508) 235-5445

277 Pleasant St
Fl 4
Fall River, MA 02721
Phone 50867632921244

277 Pleasant St
Fall River, MA 02721
Phone (508) 617-9740

500 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 973-2216

500 Faunce Corner Rd
Ste 170
North Dartmouth, MA 02747
Phone (508) 973-2216

67 Slades Ferry Ave
Somerset, MA 02726
Phone (508) 673-9400

100 Rosebrook Way
Wareham, MA 02571
Phone (508) 273-4900

Interoperability endpoints

  • Direct secure messaging: mmckenney40534@direct.southcoast.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Nurse Home Care, Inc.Fairhaven, MA, CCN 221542 Hospice Corporate Director
W-2 Managing Employee		 Jan 18, 2023
Jan 18, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 12

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1518176320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD STE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195255",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ROSEBROOK WAY",
            "city": "WAREHAM",
            "state": "MA",
            "postal_code": "025711138",
            "telephone_number": "508-273-4901",
            "fax_number": "508-973-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNEY",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "253800",
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "MA",
            "license": "253800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110095467A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmckenney40534@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "208 Mill Rd",
            "city": "Fairhaven",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027195208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wareham, MA

Sources for this page

Verify at the official NPI Registry.