MACKENZIE CAROLYN WALTZ DALLAIRE PA-C
NPI 1164188520
Physician Assistant - Surgical in Camden, NJ

NPI Status: Active since November 10, 2021

Contact Information

1601 HADDON AVE # A
CAMDEN, NJ
ZIP 08103
Phone: (856) 757-3840

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  • Individual
  • Female
  • Years of Experience 4
  • Physician Assistant
  • Surgical
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About MACKENZIE DALLAIRE

This page provides the complete NPI Profile along with additional information for Mackenzie Dallaire, a provider established in Camden, New Jersey with a medical specialization in Physician Assistant, focusing in surgical and more than 4 years of experience. The healthcare provider is registered in the NPI registry with number 1164188520 assigned on November 2021. The practitioner's primary taxonomy code is 363AS0400X with license number 25MP00728700 (NJ). The provider is registered as an individual and her NPI record was last updated one year ago.

NPI
1164188520
Provider Name
MACKENZIE CAROLYN WALTZ DALLAIRE PA-C
Gender
Female
Entity Type
Individual
Location Address
1601 HADDON AVE # A CAMDEN, NJ 08103
Location Phone
(856) 757-3840
Mailing Address
301 LIPPINCOTT DR STE 410 MARLTON, NJ 08053
Mailing Phone
(856) 757-3840
Medical School Name
OTHER
Graduation Year
2022
Is Sole Proprietor?
Yes
Enumeration Date
11-10-2021
Last Update Date
10-04-2024
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Location Map

Secondary Locations

  • 4170 City Ave
    Philadelphia, PA 19131
    (301) 641-9213

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Physician Assistant Surgical

Taxonomy Code
363AS0400X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
25MP00728700
License State
NJ

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1390200000XStudent, Health Care

Student in an Organized Health Care Education/Training Program

(PA)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Elite Bronze - HMO
  • Elite Bronze + Vision + Adult Dental - HMO
  • Elite Silver - HMO
  • Elite Silver + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Focused Silver + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Standard Gold - HMO
  • Standard Gold + Vision + Adult Dental - HMO
  • Standard Silver - HMO
  • Clear Gold - EPO
  • Clear Gold + Vision + Adult Dental - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Silver - EPO
  • Elite Silver + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Premier Bronze HSA - EPO
  • Premier Bronze HSA + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Mackenzie Dallaire is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Mackenzie Dallaire is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 5890170310

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20220920002640

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Mackenzie Dallaire is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
VIRTUA OUR LADY OF LOURDES HOSPITAL1600 HADDON AVENUE
CAMDEN, NJ 08103
(856) 886-5373Acute Care Hospitals

Reviews for MACKENZIE CAROLYN WALTZ DALLAIRE PA-C

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1164188520
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
21124281654
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 2 + 4 + 2 + 8 + 1 + 6 + 5 + 4 + 24 = 60
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1164188520 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 8 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1144877663MS. NORMA COLWELL-ROWELLO APN
Individual
Nurse Practitioner (Family)1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1609550565 KATELYN CORTES
Individual
Physician Assistant1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1619328663MS. NATHIFA AISHA GARCIA APN
Individual
Nurse Practitioner (Family)1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1801874649 JOHN S RADOMSKI MD
Individual
Transplant Surgery1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1912548579 DIANE G FARRINGTON
Individual
Nurse Practitioner (Acute Care)1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1063490860 NASSER I YOUSSEF MD
Individual
Transplant Surgery1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1407094998 ELY SEBASTIAN MD
Individual
Transplant Surgery1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840
1477183697 AMY LIANG PA
Individual
Physician Assistant1601 HADDON AVE # A
CAMDEN, NJ 08103
(856) 757-3840

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1164188520, enumerated in the NPI registry as an "individual" on November 10, 2021

The provider is located at 1601 Haddon Ave # A Camden, Nj 08103 and the phone number is (856) 757-3840

The provider's speciality is Physician Assistant with taxonomy code 363AS0400X with a focus in Surgical

The provider has more than 4 years of experience.

The provider might be accepting Accepts: Ambetter Health and Ambetter Health of Delaware. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The practitioner is affiliated to the following hospital(s): VIRTUA OUR LADY OF LOURDES HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on November 10, 2021. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.