Active NPI
Mary M Neubauer, PHD
- Clinical Psychologist
- Blue Springs, MO
National Provider Identifier
1053475186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 01502
- Practice address
- 1200 NW South Outer Rd
Suite 223
Blue Springs, MO 64015-3072 - Phone
- (816) 874-4008
- Fax
- (816) 874-4009
- NPI assigned
- Dec 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01502 | MO | Primary |
Addresses
Primary practice location
1200 NW South Outer Rd
Suite 223
Blue Springs, MO 64015-3072
Mailing address
1200 NW South Outer Rd
Suite 223
Blue Springs, MO 64015-3072
Phone (816) 874-4008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 493520316 | Medicaid | MO |
Other names 1
- Miss Mary M Biesanz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01502 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053475186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 NW SOUTH OUTER RD",
"address_2": "SUITE 223",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640153072",
"telephone_number": "816-874-4008",
"fax_number": "816-874-4009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 NW SOUTH OUTER RD",
"address_2": "SUITE 223",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640153072",
"telephone_number": "816-874-4008",
"fax_number": "816-874-4009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEUBAUER",
"first_name": "MARY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "01502",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "493520316",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "BIESANZ",
"middle_name": "M",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
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- Augustine Ai Nguyen, DO
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- Norfolk Neurodiverse Evaluations & Support, LLC
- Philip A Norfolk, PHD, BCBA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.