Active NPI
Mackenzie Faith Thompson, PA-C
- Physician Assistant
- Bloomington, IN
National Provider Identifier
1790419174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10004876A
- Practice address
- 1010 W 2ND St
Bloomington, IN 47403-2217 - Phone
- (812) 200-2458
- Fax
- (930) 200-8590
- NPI assigned
- Jul 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10004876A | IN | Primary |
Addresses
Primary practice location
1010 W 2ND St
Bloomington, IN 47403-2217
Mailing address
111 New Hampshire Ave Ste 2
Portsmouth, NH 03801-2864
Phone (330) 947-6021
Other names 1
- Mackenzie Lubbehusen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1010 W 2ND St
Bloomington, IN 47403-2217
Phone (812) 200-2458
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Dermatology and Skin Cancer Center | Past | Accepting new patients |
Interoperability endpoints
- mthompson@optima.emadirect.md
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.
-
- Clinical Medical Laboratory
- Boardman, OH
- NPI 1497912893
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752105600000",
"number": "1790419174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 NEW HAMPSHIRE AVE STE 2",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038012864",
"telephone_number": "330-947-6021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 W 2ND ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032217",
"telephone_number": "812-200-2458",
"fax_number": "930-200-8590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "MACKENZIE",
"middle_name": "FAITH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-12",
"last_updated": "2025-07-10",
"certification_date": "2025-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10004876A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MACKENZIE",
"last_name": "LUBBEHUSEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; 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.