NPIMap

Individual provider Active NPI

Karen E McKenzie, DMD

  • General Practice Dentistry
  • Wauchula, FL
National Provider Identifier
1821286287
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN18154 Issued in FL
Practice address
204 E Palmetto St
Wauchula, FL 33873-2732
Phone
(863) 773-2111
Fax
(863) 773-3284
NPI assigned
Oct 11, 2007
Last updated
Dec 21, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN18154 FL Primary

Addresses

Primary practice location

204 E Palmetto St
Wauchula, FL 33873-2732

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (863) 291-5110

Other identifiers 1

IdentifierTypeStateIssuer
076840500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160121002531 FL Order and Referring Only - DentistPractitioner - Dentist 5890098008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN18154FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. General Practice Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients
Central Florida Health Care Inc General Practice Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. General Practice Past Accepting new patients
Central Florida Health Care, Inc PastSince Jan 8, 2021 Accepting new patients
Central Florida Health Care, Inc General Practice Past Accepting new patients

Networks

  • Freedom Health HMO Network

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central Florida Health Care, Inc.-Avon ParkAvon Park, FL, CCN 101847 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care, Inc.-FrostproofFrostproof, FL, CCN 101851 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care, Inc.-DundeeDundee, FL, CCN 101935 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care IncWinter Haven, FL, CCN 101117 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care Wauchula Primary CareWauchula, FL, CCN 101143 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care IncLake Wales, FL, CCN 681066 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care IncHaines City, FL, CCN 681092 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Jan 8, 2021
Jan 8, 2021
Central Florida Health Care IncLakeland, FL, CCN 681167 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Jan 8, 2021
Jan 8, 2021
Central Florida Health Care IncLakeland, FL, CCN 681178 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care IncDavenport, FL, CCN 691010 Federally qualified health center Corporate Officer Jan 8, 2021
Central Florida Health Care IncBartow, FL, CCN C11021 Federally qualified health center Corporate Officer May 2, 2024
Central Florida Health Care IncBartow, FL, CCN C11060 Federally qualified health center Corporate Officer Jan 8, 2021

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1821286287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "863-291-5110",
            "fax_number": "863-291-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E PALMETTO ST",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338732732",
            "telephone_number": "863-773-2111",
            "fax_number": "863-773-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "KAREN",
        "middle_name": "E",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-11",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076840500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauchula, FL

Sources for this page

Verify at the official NPI Registry.