Diane E McKenzie, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209003923 Issued in IL

Practice address

11200 W Lincoln Hwy
Mokena, IL 60448-8208

Phone

(815) 464-2171

Fax

(815) 464-2176

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Nurse Practitioner

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premise Health of Illinois Medical PCGroup PAC ID 3971764762, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Premise Health of Illinois Medical PC

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  Medicare reassignment Care Compare group NPD
• Premise Health of Illinois Medical PC

  • Multi-Specialty Clinic/Center
  • Countryside, IL
  • NPI 1083006001
  NPD
• Premise Health of Illinois Medical PC

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1750476248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12311 S MORGAN ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276222",
            "telephone_number": "708-396-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 W LINCOLN HWY",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488208",
            "telephone_number": "815-464-2171",
            "fax_number": "815-464-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "DIANE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209003923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209003923",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Lynn McEnery
• Sheryl McEvoy, CCC-SLP
• Rosemary McGrath, MD
• Mary McIntyre
• Emily McKenna
• Kathleen Claire McLoughlin, MS, CCC-SLP
• MD2X S.C.
• MDM Advanced Ancillary Services, LLC
• Medic 1
• Megan Maiero PLLC

• Family Nurse Practitioner in Mokena, IL
• Providers in Mokena, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.