Active NPI
Mark McKinley, PSY.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1750545331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 022043
- Practice address
- 1745 Broadway
17TH FL.
New York, NY 10019-4640 - Phone
- (212) 851-8100
- Fax
- (212) 537-0102
- NPI assigned
- Jul 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 022043 | NY | Primary |
| Psychologist | 103T00000X | 26095 | CA |
Addresses
Primary practice location
1745 Broadway
17TH FL.
New York, NY 10019-4640
Mailing address
1745 Broadway
17TH FL.
New York, NY 10019-4640
Phone (212) 851-8100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2825 3Rd Ave
Suite 402
Bronx, NY 10455-4066
Phone (718) 520-8000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26095 | CA | MD | Pharmacist |
| 022043 | NY | MD | Physical Therapist |
Organizations & group practices 1
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.
-
- Psychiatry Physician
- Bronx, NY
- NPI 1679244768
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1750545331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1745 BROADWAY",
"address_2": "17TH FL.",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100194640",
"telephone_number": "212-851-8100",
"fax_number": "212-537-0102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 BROADWAY",
"address_2": "17TH FL.",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100194640",
"telephone_number": "212-851-8100",
"fax_number": "212-537-0102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-14",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "022043",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "26095",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.