NPIMap

Individual provider Active NPI

Mackenzie B Walker

  • Physician Assistant
  • Saint Albans, VT
National Provider Identifier
1851869291
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
055.0031576 Issued in VT
Practice address
12 Crest Rd
Saint Albans, VT 05478-9701
Phone
(802) 524-4554
NPI assigned
Nov 3, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 023473 NY
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 055.0031576 VT Primary

Addresses

Primary practice location

12 Crest Rd
Saint Albans, VT 05478-9701

Mailing address

12 Crest Rd
Saint Albans, VT 05478-9701
Phone (802) 524-4554

Other practice location 1

25 Degrandpre Way
Plattsburgh, NY 12901-6449
Phone (518) 563-3260

Other practice location 2

28 Nash Pl # 3
28 Nash Pl #3
Burlington, VT 05401-1420
Phone (802) 777-9717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, VT2 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
I20190814001369 NY Practitioner - Physician Assistant 2365779352
I20220502001837 VT Practitioner - Physician Assistant 2365779352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
The Richford Health Center, Inc.Group PAC ID 7012825631, 30 clinicians

Practice addresses (Care Compare)

12 Crest Rd
Saint Albans, VT 05478-9701
Phone (802) 524-4554

3 Crest Rd
Saint Albans, VT 05478-9753
Phone (802) 524-4554

64 Industrial Park Rd
Alburg, VT 05440-4170
Phone (802) 796-4414

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
023473NYMDPhysician Assistant
055.0031576VTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Richford Health Center Inc CurrentSince May 2, 2022 Accepting new patients
The Richford Health Center Inc Past Accepting new patients
The Richford Health Center Inc Past Accepting new patients

Locations

44 Main St
Ste 200
Richford, VT 05476
Phone (802) 255-5500

26 Canada St
Swanton, VT 05488
Phone (800) 868-2454

Interoperability endpoints

  • Direct secure messaging: mackenziew@notch.medentdirect.com

Organizations & group practices 4

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 8

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": "1541203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1851869291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CREST RD",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054789701",
            "telephone_number": "802-524-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CREST RD",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054789701",
            "telephone_number": "802-524-4554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Degrandpre Way",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129016449",
            "country_code": "US",
            "telephone_number": "518-563-3260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28 Nash Pl # 3",
            "address_2": "28 Nash Pl #3",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "VT",
            "postal_code": "054011420",
            "country_code": "US",
            "telephone_number": "802-777-9717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "MACKENZIE",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-03",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023473",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Albans, VT

Sources for this page

Verify at the official NPI Registry.