Mackenzie Ann Waggoner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12258 Issued in TN

Practice address

1035 S Hartmann Dr
Lebanon, TN 37090-4064

Phone

(615) 321-3310

Fax

(615) 443-5488

NPI assigned

Feb 20, 2018

Last updated

Oct 26, 2023By the provider in NPPES

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 TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Sports Medicine and Orthopaedic Center PLCGroup PAC ID 8729009634, 90 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.78 of 100Reported as group

Quality

65.3

Promoting interoperability

96

Improvement activities

40

Cost

77.31

Medicare enrollment (NPD)

Enrolled

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

• Elite Sports Medicine and Orthopaedic Center, PLC

  • Specialist
  • Nashville, TN
  • NPI 1528281623
  Medicare reassignment Care Compare group NPD
• Tennessee Orthopaedic Alliance PA

  • Orthopaedic Surgery Physician
  • Nashville, TN
  • NPI 1538153937
  Medicare reassignment NPD
• Elite Sports Medicine and Orthopaedic Center, PLC

  • Orthopaedic Surgery Physician
  • Brentwood, TN
  • NPI 1669115622
  NPD
• Tennessee Orthopaedic Alliance PA

  • Orthopaedic Surgery Physician
  • Manchester, TN
  • NPI 1164660213
  NPD
• Tennessee Orthopaedic Alliance PA

  • Multi-Specialty Clinic/Center
  • Clarksville, TN
  • NPI 1336905561
  NPD

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1891295549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306556",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306556",
            "telephone_number": "615-329-2294",
            "fax_number": "615-695-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 S HARTMANN DR",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370904064",
            "telephone_number": "615-321-3310",
            "fax_number": "615-443-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "MACKENZIE",
        "middle_name": "ANN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-20",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "12258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wal-Mart Stores East LP (Walmart Pharmacy 10-0671)
• Wal-Mart Stores East, LP (Vision Center 30-0671)
• Walgreen Co
• Walgreen Co (Walgreens #05953)
• Walgreen Co (Walgreens #12513)

• Physical Therapist in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.