MACKENZIE DOUGHERTY RD, CD
NPI 1053612283
Dietitian, Registered in Saint Paul, MN
About Mackenzie Dougherty Rd, Cd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MACKENZIE DOUGHERTY RD, CD (NPI 1053612283) is an individual dietitian, registered in Saint Paul, Minnesota, licensed in Minnesota (3882) and active in the NPI registry since November 2010. She maintains a secondary practice location in Madison and is a graduate of Other (2002).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mackenzie Dougherty Rd, Cd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Mackenzie Dougherty reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
St Paul, MN 55108
- Reassigned Medicare billing, Minnesota enrollment
- 121 clinicians in this Medicare group
Minneapolis, MN 55414
- Reassigned Medicare billing, Minnesota enrollment
- 1,453 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55108 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAINT PAUL, MN 55108
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mackenzie Dougherty's NPI number?
The NPI number for Mackenzie Dougherty is 1053612283. It was assigned to this individual provider in the NPPES registry on November 4, 2010.
Where is Mackenzie Dougherty located?
Mackenzie Dougherty practices at 2265 Como Ave, Saint Paul, MN 55108. The listed phone number is (651) 645-5323.
What is Mackenzie Dougherty's specialty?
The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.
Is Mackenzie Dougherty enrolled in Medicare?
Yes. Mackenzie Dougherty is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Mackenzie Dougherty's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mackenzie Dougherty reassigns Medicare benefits to 2 organizations: Emily Program P C (St Paul, MN) and University Of Minnesota Physicians (Minneapolis, MN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mackenzie Dougherty's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mackenzie Dougherty was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mackenzie Dougherty, RD, CD · NPI 1053612283
Dietitian, Registered provider in Saint Paul, Minnesota. Individual provider, active in the CMS NPPES registry since November 4, 2010.
## Identity
- **NPI:** 1053612283 (Entity type: Individual)
- **Enumerated:** November 4, 2010
- **Primary specialty:** Dietitian, Registered · taxonomy 133V00000X
- **State license:** 3882 (Minnesota)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2265 COMO AVE, Saint Paul, MN 55108-1737
- **Phone:** (651) 645-5323
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Emily Program P C (NPI 1528165065, St Paul, MN); University Of Minnesota Physicians (NPI 1477598118, Minneapolis, MN) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2002
## Record status
- **NPPES last updated:** March 17, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1053612283) · Data from the CMS NPPES public registry.