Mary I Bowers, MD
Individual provider Active NPI Pediatrics Physician · Sheridan, WY
NPI 1023047339 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023047339
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 5199A (WY)
- Practice address
- 1701 W 5TH St
Ste a
Sheridan, WY 82801-2748 - Phone
- (307) 672-7700
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
600 W Fulton
Chicago, IL 60661-1262
600 W Fulton St
Suite 300
Chicago, IL 60661-1259
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251224001791 | IL | Practitioner - Pediatric Medicine | 4082615414 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5199A | WY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Community Health Network | Current |
Accepting new patients | |
| Access Community Health Network | Past | Accepting new patients | |
| Obstetrix Medical Group of Colorado P C | Past | Accepting new patients |
Locations
6020 W Diversey Ave
Bldg W
Chicago, IL 60639
Phone (773) 237-5544
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5199A | WY | Yes |
Addresses
Primary practice location
1701 W 5TH St
Ste a
Sheridan, WY 82801-2748
Mailing address
1701 W 5TH St
Ste a
Sheridan, WY 82801-2748
Phone (307) 672-7700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000011895 | Other | WY | MONTANA MEDICAID |
| 303760 | Other | WY | BLUE CROSS |
Other providers in Sheridan, WY
- Karlie Boomgarden
- Donald Edwin Boone
- Grant Griffin Boostrom
- Tara Bower
- Erin Nicole Bowers
- Shauna Kaye Bowers
- Kelley Boyd
- Sarah Boyko
- Katrina Andrea Bramstedt
- Dianne Bramwell
All providers in Sheridan, WY · Pediatrics Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.