McKenzie Gail Breault

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

600 S 43Rd St
Philadelphia, PA 19104-4418

Phone

(715) 220-7117

NPI assigned

Jun 24, 2024

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 WI

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ladd Memorial HospitalGroup PAC ID 9931092848, shared by 3 NPIs, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ladd Memorial Hospital Hospital, Osceola, WI, CCN 521318

Medicare enrollment (NPD)

Enrolled

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.

• Ladd Memorial Hospital

  • Critical Access Hospital
  • Osceola, WI
  • NPI 1467560227
  Medicare reassignment

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

• Ladd Memorial Hospital

  • Critical Access Hospital
  • Osceola, WI
  • NPI 1467560227
  Care Compare affiliation

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1992549984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 LEILA LN",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "540171083",
            "telephone_number": "715-220-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 43RD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044418",
            "telephone_number": "715-220-7117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1528 Leila Ln",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "540171083",
            "country_code": "US",
            "telephone_number": "715-220-7117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BREAULT",
        "first_name": "MCKENZIE",
        "middle_name": "GAIL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breaking Boundaries Wellness Center, LLC
• Breakthrough Therapeutic Services LLC
• Kent D Bream, MD
• Breast-Pump-Rental.Com
• Breathe New Life, LLC.
• Candace Breaux
• Federica Sternini Brecha, MD
• Steven William Breecker, M.D.
• Elise Ristig Breed, MD, PHD
• Zachari Breeding, RD, LDN

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.