Mackenzie Shallenberger, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-004155 Issued in IL

Practice address

640 W Washington St
Pittsfield, IL 62363-1350

Phone

(217) 285-2113

Fax

(217) 277-3960

NPI assigned

Feb 20, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Blessingcare CorporationGroup PAC ID 2769420959, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Illini Community Hospital Hospital, Pittsfield, IL, CCN 141315
• Blessing Hospital Hospital, Quincy, IL, CCN 140015

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.

• Blessingcare Corporation

  • Critical Access Hospital
  • Pittsfield, IL
  • NPI 1720086218
  Medicare reassignment Care Compare group NPD
• Blessingcare Corporation

  • Emergency Medicine Physician
  • Pittsfield, IL
  • NPI 1992038640
  Medicare reassignment
• Blessingcare Corporation

  • Hematology & Oncology Physician
  • Pittsfield, IL
  • NPI 1356674006
  NPD
• Blessingcare Corporation

  • Social Worker
  • Pittsfield, IL
  • NPI 1972908390
  NPD
• Cardiac Surgery Associates SC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Downers Grove, IL
  • NPI 1043269160
  NPD (past)

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

• Blessing Hospital

  • Nurse Practitioner
  • Quincy, IL
  • NPI 1417204827

  Hospital

  Care Compare affiliation
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  Care Compare affiliation
• Blessingcare Corporation

  • Critical Access Hospital
  • Pittsfield, IL
  • NPI 1720086218
  Care Compare affiliation

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

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1942573001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 WARRENVILLE RD",
            "address_2": "STE. 280",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151748",
            "telephone_number": "630-324-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W WASHINGTON ST",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631350",
            "telephone_number": "217-285-2113",
            "fax_number": "217-277-3960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Warrenville Rd",
            "address_2": "Ste. 280",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605151748",
            "country_code": "US",
            "telephone_number": "630-324-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHALLENBERGER",
        "first_name": "MACKENZIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-20",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-004155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1101093",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Lynette Roth
• Robert Rowles, CRNA
• Brandi N. Ruzich, PHYSICAL THERAPIST
• Eden Ryan
• Tracy Schutte
• Tyler Shepherd, BS
• Makenzie Shipman
• Ronald Short, D.C.
• James M Shumake, D.O.
• Martha Slater, PTA

• Physician Assistant in Pittsfield, IL
• Providers in Pittsfield, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.