Individual provider Active NPI

Mackenzie Ryan Monahan, PA-C, MPAS

  • Physician Assistant
  • Windsor, VT
National Provider Identifier
1972920619
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1007 Issued in NH
Practice address
289 County Rd
Windsor, VT 05089-9000
Phone
(802) 674-7300
NPI assigned
Mar 19, 2014
Last updated
Dec 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1007 NH Primary

Addresses

Primary practice location

289 County Rd
Windsor, VT 05089-9000

Mailing address

289 County Rd
Windsor, VT 05089-9000
Phone (802) 674-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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

Enrollment IDStateProvider typePAC IDDetails
I20150109000320 VT Practitioner - Physician Assistant 1658595012 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Windsor Hospital CorporationGroup PAC ID 2860387214, shared by 6 NPIs, 56 clinicians

Practice addresses (Care Compare)

289 County Rd
Windsor, VT 05089-9000
Phone (802) 674-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1007NHMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Windsor Hospital Corporation CurrentSince Nov 12, 2014 Accepting new patients
Windsor Hospital Corporation CurrentSince Nov 12, 2014 Accepting new patients
Windsor Hospital Corporation CurrentSince Sep 27, 2025 Accepting new patients

Locations

289 County Rd
Windsor, VT 05089
Phone (802) 674-7220

Organizations & group practices 3

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 3

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": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1972920619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "289 COUNTY RD",
            "city": "WINDSOR",
            "state": "VT",
            "postal_code": "050899000",
            "telephone_number": "802-674-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 COUNTY RD",
            "city": "WINDSOR",
            "state": "VT",
            "postal_code": "050899000",
            "telephone_number": "802-674-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONAHAN",
        "first_name": "MACKENZIE",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, VT

Sources for this page

Verify at the official NPI Registry.