NPIMap

Individual provider Active NPI

Matthew James Mackay, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Overland Park, KS
National Provider Identifier
1790213783
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
04-45829 Issued in KS
Practice address
10701 Nall Ave Ste 200
Overland Park, KS 66211-1358
Phone
(806) 680-2652
NPI assigned
Jun 2, 2017
Last updated
Nov 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 2022008451 MO
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 04-45829 KS Primary

Addresses

Primary practice location

10701 Nall Ave Ste 200
Overland Park, KS 66211-1358

Mailing address

10701 Nall Ave Ste 200
Overland Park, KS 66211-1358
Phone (806) 680-2652

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230508002349 MO Practitioner - Orthopedic Surgery 8426320979 Reassigns benefits to 1 organization
I20230622003057 KS Practitioner - Orthopedic Surgery 8426320979 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Texas Medical Branch at Galveston, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Medical Group of KC PAGroup PAC ID 7618144056, 27 clinicians

Practice addresses (Care Compare)

10701 Nall Ave
Suite 200
Overland Park, KS 66211-1358
Phone (913) 381-5225

3151 NE Carnegie Dr
Suite B
Lees Summit, MO 64064-3218
Phone (913) 381-5225

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)48
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022008451MOMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Medical Group of KC, PA CurrentSince Jul 1, 2023 Accepting new patients
Signature Medical Group of KC, P.a. CurrentSince Jul 1, 2023 Accepting new patients

Locations

10701 Nall Ave
Ste 200
Overland Park, KS 66211
Phone (913) 381-5225

1800 E Meyer Blvd
Kansas City, MO 64132
Phone (816) 523-0100

3151 NE Carnegie Dr
Ste B
Lees Summit, MO 64064
Phone (816) 525-2800

Interoperability endpoints

  • Direct secure messaging: matthew.mackay@kcbj.eclinicaldirectplus.com
  • Direct secure messaging: mmackay755672@direct.kuha.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1790213783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10701 NALL AVE STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111358",
            "telephone_number": "806-680-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10701 NALL AVE STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111358",
            "telephone_number": "806-680-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKAY",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-02",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MO",
            "license": "2022008451",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "KS",
            "license": "04-45829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.