Individual provider Active NPI

Alexandra Maria McKane, DO

  • Family Medicine Physician
  • Clinton, TN
National Provider Identifier
1578128666
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4779 Issued in TN
Practice address
102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone
(865) 457-4702
Fax
(865) 374-2115
NPI assigned
May 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PA
Family Medicine Physician 207Q00000X 4779 TN Primary

Addresses

Primary practice location

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916

Mailing address

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone (865) 457-4702

Other identifiers 1

IdentifierTypeStateIssuer
Q076719MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mckane.alexandra.maria@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20221013002153 TN Practitioner - Family Practice 4981070158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone (865) 457-4702

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4779TNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc CurrentSince Sep 1, 2022 Accepting new patients
Covenant Medical Group, Inc. Family Medicine CurrentSince Sep 1, 2022 Accepting new patients

Locations

102 S Seivers Blvd
Clinton, TN 37716
Phone (865) 457-4702

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Interoperability endpoints

  • Direct secure messaging: mckane.alexandra.maria@covenanthealth.cernerdirect.com

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.

Hospital & facility affiliations 1

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": "1557014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1578128666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377163916",
            "telephone_number": "865-457-4702",
            "fax_number": "865-374-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377163916",
            "telephone_number": "865-457-4702",
            "fax_number": "865-374-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKANE",
        "first_name": "ALEXANDRA",
        "middle_name": "MARIA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-05",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "4779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q076719",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mckane.alexandra.maria@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "102 S Charles G Seivers Blvd",
            "city": "Clinton",
            "state": "TN",
            "country_code": "US",
            "postal_code": "377163916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton, TN

Sources for this page

Verify at the official NPI Registry.