DR. CLARK R MCKENZIE (NPI# 1073506051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073506051 |
| Entity Type | Individual |
| Full Name | DR. CLARK R MCKENZIE |
| Credential | MD |
| Practice Address |
450 N New Ballas Rd Ste 270 W Saint Louis MO 63195-2632 |
| Practice Telephone | 3149916969 |
| Practice Fax Number | 3149976969 |
| Mailing Telephone | 3149916969 |
| Mailing Fax Number | 3149976969 |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2016-01-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
R4P62 | MO | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
R4P62 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | RR CCL GROUP | P00275849 | 01 |
| MO | RR MEDICARE NUMBER | 110171721 | 01 |
| MO | RR GROUP 99 | CI7050 | 01 |
| MO | FARM GROUP NPI | 1881863009 | 01 |
| MO | CCL INDIVDUAL PROV NUMBER | MA1080001 | 01 |
| MO | HHC CATH GROUP NPI | 1124011010 | 01 |
| MO | STL GROUP NPI | 1801889795 | 01 |
| MO | CCL GROUP NUMBER | MA1080 | 01 |
| MO | MCARE CCL GROUP NUMBER | 000047049 | 01 |
| MEDICARE PROVIDER ID | 006012762 | 01 | |
| MO | MEDICARE PROV ID AREA 99 | 004013185 | 01 |
| MO | RR GROUP 01 | CD6536 | 01 |
| Street Address |
450 N NEW BALLAS RD STE 270 W |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63195-2632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176860 | Mary Carolyn Gamache | Internal Medicine | 450 N New Ballas Rd, Suite 170, Saint Louis, MO 63141-6835 | 2005-07-01 |
| 1396107959 | Hhc Health Care, LLC | Internal Medicine | 450 N New Ballas Rd, Suite 202 South Wing, Saint Louis, MO 63141-6835 | 2016-03-23 |
| 1164824652 | Hhc Health Care, LLC | Internal Medicine | 450 N New Ballas Rd, Ste 270 West Wing, Saint Louis, MO 63141-6835 | 2014-09-16 |
| 1043612534 | Hhc Asc, LLC | Clinic/Center | 450 N New Ballas Rd, Ste. 206 South Wing, Saint Louis, MO 63141-6835 | 2014-09-16 |
| 1538468558 | Thomas J Smith | Nurse Anesthetist, Certified Registered | 450 N New Ballas Rd, Saint Louis, MO 63141-6835 | 2011-03-16 |
| 1942508023 | Pearl Imaging, LLC | Clinic/Center | 450 N New Ballas Rd, Suite 20-ll, Saint Louis, MO 63141-6835 | 2011-03-14 |
| 1902049877 | Heart Health Center Ambulatory Surgery Center. LLC | Clinic/Center | 450 N New Ballas Rd, Suite 110 South Wing, Saint Louis, MO 63141-6835 | 2009-04-08 |
| 1427219286 | Christopher Black | Anesthesiology | 450 N New Ballas Rd, Saint Louis, MO 63141-6835 | 2008-06-24 |
| 1396923694 | St. Luke's Whc, LLC | Radiology | 450 N New Ballas Rd, Suite 250, Saint Louis, MO 63141-6835 | 2008-02-08 |
| 1013130376 | Beth Anne Basler | Nurse Practitioner | 450 N New Ballas Rd, Suite 270, Saint Louis, MO 63141-6835 | 2007-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033326137 | Luke S Choi | Orthopaedic Surgery | 14285 N. Outer Forty Rd, Suite 200, Chesterfield, MO 63195-0000 | 2007-05-17 |
| 1831160761 | Anthony S Shen | Internal Medicine | 3009 N Ballas Rd Suite 315a, Saint Louis, MO 63195-2485 | 2006-01-30 |
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437658440 | Cardiac Cin of St Louis LLC | Internal Medicine | 11628 Old Ballas Rd # 346, Saint Louis, MO 63141-7030 | 2018-02-05 |
| 1053401422 | Gus Theodos | Internal Medicine | 710 S Price Rd, Saint Louis, MO 63124-1867 | 2006-10-13 |
| 1013909613 | Paul H Gibson | Internal Medicine | 11188 Tesson Ferry Road, Suite 100, Saint Louis, MO 63123 | 2005-08-19 |
| 1629207477 | Elsayed Salem Abo-salem | Internal Medicine | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2009-07-14 |
| 1538302567 | Edward David Coverstone | Internal Medicine | 10012 Kennerly Rd, Suite 300, Saint Louis, MO 63128-2197 | 2009-04-06 |
| 1962509992 | County Cardiology, Inc. | Internal Medicine | 10004 Kennerly Rd, Suite 247, Saint Louis, MO 63128-2141 | 2006-09-20 |
| 1548274749 | Sundeep Das | Internal Medicine | 11155 Dunn Rd, Ste 304e, Saint Louis, MO 63136-6150 | 2006-07-27 |
| 1396769055 | Rafiq Ramadan | Internal Medicine | 11155 Dunn Rd, Ste 304e, Saint Louis, MO 63136-6150 | 2006-07-27 |
| 1346264017 | Harvey Serota | Internal Medicine | 11155 Dunn Rd, Ste 304e, Saint Louis, MO 63136-6150 | 2006-07-27 |
| 1437173119 | Gil M Vardi | Internal Medicine | 11155 Dunn Rd, Ste 304e, Saint Louis, MO 63136-6150 | 2006-07-27 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63195 |
Please comment or provide details below to improve the information on DR. CLARK R MCKENZIE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.