Mary S Bannon, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

158347 Issued in MA

Practice address

671 Main St
Waltham, MA 02451-0602

Phone

(781) 647-3040

Fax

(781) 647-3044

NPI assigned

Oct 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/86/brand/1/csg/1/fhir/r4

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.

• Mount Auburn Professional Services Inc

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1992750996
  NPD (past)
• Mt Auburn Professional Services

  • Internal Medicine Physician
  • Cambridge, MA
  • NPI 1013375203
  NPD (past)

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501200000000",
    "number": "1043392590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 HIGH STREET SUITE 101",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "01845",
            "telephone_number": "978-685-2460",
            "fax_number": "978-685-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024510602",
            "telephone_number": "781-647-3040",
            "fax_number": "781-647-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "MARY",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2017-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "158347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devasena Balasubramaniam, M.D.
• Laura M Balducci, MAOM
• Jenna Bancroft, LICSW
• Heena Banker, M.D.
• Omari Banner
• Barbara J Doyle Counseling Services Professional LLC
• Marygrace Davie Barber, N.P.
• Brenden Omar Bardales
• Katherine Michelle Baril
• Brittany Michelle Barker

• Gerontology Nurse Practitioner in Waltham, MA
• Providers in Waltham, MA by specialty
• Gerontology Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.