Individual provider Active NPI

Mackenzie A McKellips, PA-C

  • Physician Assistant
  • Rochester, MN
National Provider Identifier
1619306917
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11466 Issued in MN
Practice address
5067 55TH St NW
Rochester, MN 55901-3809
Phone
(507) 292-7070
NPI assigned
Nov 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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 11466 MN Primary

Addresses

Primary practice location

5067 55TH St NW
Rochester, MN 55901-3809

Mailing address

5067 55TH St NW
Rochester, MN 55901-3809
Phone (507) 292-7070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20131217000446 MN Practitioner - Physician Assistant 4486881554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olmsted Medical CenterGroup PAC ID 8527970060, 324 clinicians

Practice addresses (Care Compare)

132 17TH Ave NW
Suite 132
Rochester, MN 55901-0321
Phone (507) 292-7411

1650 4TH St SE
Rochester, MN 55904-4717

5067 55TH St NW
Rochester, MN 55901-3809
Phone (507) 292-7070

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Olmsted Medical Center CurrentSince Aug 3, 2015 Accepting new patients
Olmsted Medical Center Past Accepting new patients
Ladd Memorial Hospital Past Accepting new patients

Locations

846 High Point Dr NE
Byron, MN 55920
Phone (507) 775-2128

1705 N Highway 20
Cannon Falls, MN 55009
Phone (507) 263-4900

207 Twiford St SW
Chatfield, MN 55923
Phone (507) 867-4901

507 W Doughty St
Lake City, MN 55041
Phone (651) 345-2350

111 County Road 11 NW
Pine Island, MN 55963
Phone (507) 356-2476

20 2nd Ave NE
Plainview, MN 55964
Phone (507) 534-3885

405 Kansas St NW
Preston, MN 55965
Phone (507) 765-5324

132 17th Ave NW
Ste 132
Rochester, MN 55901
Phone (507) 292-7411

1544 Greenview Dr SW
Rochester, MN 55902
Phone (507) 287-2711

4303 Highway 52 N
Rochester, MN 55901
Phone (507) 287-2714

318 1st Ave SW
Ste 203
Rochester, MN 55902
Phone (507) 292-7250

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

5155 55th St NW
Rochester, MN 55901
Phone (507) 292-7174

5067 55th St NW
Rochester, MN 55901
Phone (507) 292-7070

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

403 W 4th St
Saint Charles, MN 55972
Phone (507) 534-3885

802 Memorial Dr
Spring Valley, MN 55975
Phone (507) 346-7373

208 Ctr Town Plz N
Stewartville, MN 55976
Phone (507) 533-4727

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.

NPI Registry JSON

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1619306917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELLIPS",
        "first_name": "MACKENZIE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-06",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.