Mackenzie E Douglass, MSN, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

95212458 Issued in CA

Practice address

1505 Soquel Dr Ste 1
Santa Cruz, CA 95065-1716

Phone

(831) 465-5440

Fax

(831) 462-2017

NPI assigned

Jun 12, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Master of Science - Nursing

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mackenzie.douglass@450265012305924.direct.elationemr.com

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.

• Salud Para la Gente

  • Federally Qualified Health Center (FQHC)
  • Watsonville, CA
  • NPI 1730169756
  Medicare reassignment NPD
• Salud Para la Gente

  • Federally Qualified Health Center (FQHC)
  • Santa Cruz, CA
  • NPI 1356540587
  NPD
• Salud Para la Gente

  • Federally Qualified Health Center (FQHC)
  • Seaside, CA
  • NPI 1700142544
  NPD
• University Hospitals Regional Practices LLC

  • Internal Medicine Physician
  • Shaker Heights, OH
  • NPI 1336602218
  NPD (past)

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1922446889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "address_2": "ATTN CREDENTIALING/PAYER ENROLLMENT",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 SOQUEL DR STE 1",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651716",
            "telephone_number": "831-465-5440",
            "fax_number": "831-462-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "MACKENZIE",
        "middle_name": "E",
        "credential": "MSN, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-12",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OH",
            "license": "APRN.CNM.019342",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": "209.010345",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "95212458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Claire Doty, BSN, RN
• Christina Catherine Doubek, L.V.N.
• Emily Doughy-Wood
• Corrine Lee Douglas, NP
• Demitra Douglas
• Michael Joseph Douglass, R.N.
• Trent Dover, PARAMEDIC
• Judy Dowd, CNM
• Meganne Downs
• Michelle Muriel Doyle, RN

• Advanced Practice Midwife in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Advanced Practice Midwife in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.