Individual provider Active NPI

Mary S Mazanec, NP

  • Pediatric Nurse Practitioner
  • Norwell, MA
National Provider Identifier
1003974585
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
263381 Issued in MA
Practice address
75 Washington Street
Norwell, MA 02061-9147
Phone
(781) 878-5200
Fax
(781) 878-3989
NPI assigned
Dec 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 263381 MA Primary

Addresses

Primary practice location

75 Washington Street
Norwell, MA 02061-9147

Mailing address

75 Washington St
Norwell, MA 02061-1795
Phone (781) 878-5200

Other identifiers 8

IdentifierTypeStateIssuer
042297845OtherMAGREAT WEST HEALTH CARE
NP5514OtherMAMEDICARE
042297845OtherMAPHCS
042297845OtherMULTI-PLAN
0710661MedicaidMA
121285OtherMAFALLON
042297845OtherMATRICARE
NP9628OtherMABCBSMA

Other names 1

  • Mary S Sullivan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20070118000289 MA Practitioner - Nurse Practitioner 5597766543 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
263381MAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Associates CurrentSince Apr 10, 2020 Accepting new patients
South Shore Medical Center, Inc. CurrentSince Aug 29, 2010 Accepting new patients

Locations

5 Tarkiln Rd
Kingston, MA 02364
Phone (781) 585-2200

141 Longwater Dr
Ste 201
Norwell, MA 02061
Phone (781) 261-7820

143 Longwater Dr
Norwell, MA 02061
Phone (781) 792-4136

75 Washington St
Norwell, MA 02061

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

55 Fogg Rd
#81
Weymouth, MA 02190

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297296000000",
    "number": "1003974585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 WASHINGTON ST",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "020611795",
            "telephone_number": "781-878-5200",
            "fax_number": "781-878-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 WASHINGTON STREET",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "020619147",
            "telephone_number": "781-878-5200",
            "fax_number": "781-878-3989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZANEC",
        "first_name": "MARY",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "263381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST HEALTH CARE",
            "identifier": "042297845",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NP5514",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "042297845",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-PLAN",
            "identifier": "042297845",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0710661",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "121285",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "042297845",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "NP9628",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SULLIVAN",
            "middle_name": "S",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Norwell, MA

Sources for this page

Verify at the official NPI Registry.