MACKENZIE DERMATOLOGY
NPI 1396971958
Dermatology - Procedural Dermatology in Prescott, AZ
About Mackenzie Dermatology NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MACKENZIE DERMATOLOGY (NPI 1396971958) is a healthcare organization registered as a procedural dermatology in Prescott, Arizona and active in the NPI registry since June 2009. The organization holds a CLIA Certificate of Compliance certificate valid through October 28, 2027 and lists Jamie Quinn, Credentialing/billing Supervisor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 3
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mackenzie Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Mackenzie Dermatology, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Compliance 03D2011524
Mackenzie Dermatology · Prescott, AZFrequently 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 Keith A Mackenzie Do PC's NPI number?
The NPI number for Keith A Mackenzie Do PC is 1396971958. It was assigned to this organization in the NPPES registry on June 9, 2009. The provider is doing business as Mackenzie Dermatology.
Where is Keith A Mackenzie Do PC located?
Keith A Mackenzie Do PC is located at 3190 Clearwater Dr, Prescott, AZ 86305. The listed phone number is (928) 541-1312.
What is Keith A Mackenzie Do PC's specialty?
The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.
Is Keith A Mackenzie Do PC enrolled in Medicare?
Yes. Keith A Mackenzie Do PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Keith A Mackenzie Do PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Keith A Mackenzie Do PC, in Dermatology and Nurse Practitioner. A 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 the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Keith A Mackenzie Do PC hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 03D2011524) is associated with this NPI, valid through October 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Keith A Mackenzie Do PC was last updated on October 18, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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 Dermatology · NPI 1396971958
Procedural Dermatology organization in Prescott, Arizona. Organization record, active in the CMS NPPES registry since June 9, 2009.
## Identity
- **NPI:** 1396971958 (Entity type: Organization)
- **Enumerated:** June 9, 2009
- **Primary specialty:** Dermatology - Procedural Dermatology · taxonomy 207NS0135X
- **Legal business name:** Keith A Mackenzie Do Pc
- **Organization subpart:** No
- **Authorized official:** Jamie Quinn, CREDENTIALING/BILLING SUPERVISOR
## Practice location
- **Address:** 3190 CLEARWATER DR, Prescott, AZ 86305-7131
- **Phone:** (928) 541-1312 · **Fax:** (928) 541-0002
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (2), Nurse Practitioner (2); 2 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 18, 2017
- **Other identifiers:** Medicare PIN 20138 (AZ); Medicaid 390766 (AZ); Medicare UPIN G53808
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1396971958) · Data from the CMS NPPES public registry.