Mackenzie Lynn Roth, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2021010020 Issued in MO

Practice address

5194 Jeremiah Blvd
Hillsboro, MO 63050-5815

Phone

(636) 543-2328

Fax

(636) 543-2329

NPI assigned

Jun 1, 2021

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

Medicare fee-for-service enrollment

Enrolled in MO, TX2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023
• Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228
  Medicare reassignment Care Compare group NPD
• Ste Genevieve County Memorial Hospital

  • Rural Health Clinic/Center
  • Bloomsdale, MO
  • NPI 1184658387
  Medicare reassignment
• Ste Genevieve County Memorial Hospital

  • Rural Health Clinic/Center
  • Ste Genevieve, MO
  • NPI 1730238551
  Medicare reassignment
• Communitymed PCP

  • Primary Care Clinic/Center
  • Melissa, TX
  • NPI 1063818219
  Medicare reassignment
• Communitymed PLLC

  • Urgent Care Clinic/Center
  • Melissa, TX
  • NPI 1821417072
  Medicare reassignment
• Mercy Clinic East Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Ballwin, MO
  • NPI 1700370061
  NPD
• Ste Genevieve County Memorial Hospital

  • Family Medicine Physician
  • Ste Genevieve, MO
  • NPI 1194033589
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Jefferson

  • General Acute Care Hospital
  • Festus, MO
  • NPI 1508859661
  Care Compare affiliation
• Mercy Hospital South

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1568481984
  Care Compare affiliation

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1831765759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "636-543-2328",
            "fax_number": "636-543-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5194 JEREMIAH BLVD",
            "city": "HILLSBORO",
            "state": "MO",
            "postal_code": "630505815",
            "telephone_number": "636-543-2328",
            "fax_number": "636-543-2329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 Boderman",
            "address_purpose": "LOCATION",
            "city": "Bloomsdale",
            "state": "MO",
            "postal_code": "636279099",
            "country_code": "US",
            "telephone_number": "573-483-2929",
            "fax_number": "573-483-9612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "MACKENZIE",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2021010020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garrett Rhine, D.C.
• Edith Kaye Robinson, RN
• Theresa Lynn Robson, LMSW
• Kimberly Ann Rodriguez
• David Rose
• Amy Marie Saak, FNP-C
• Ashley Elizabeth Scaglione, PA-C
• Chastity L Scott
• Stuart J Scott, DDS
• Shah Enterprises LLC

• Medical Physician Assistant in Hillsboro, MO
• Providers in Hillsboro, MO by specialty
• Medical Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.