Active NPI
Mary M. Beatty-Roloff, APNP
- Nurse Practitioner
- Waupaca, WI
National Provider Identifier
1053505362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 3195
- Practice address
- N2919 Cty Hwy QQ
Waupaca, WI 54981 - Phone
- (715) 258-2108
- Fax
- (715) 942-2199
- NPI assigned
- Aug 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3195 | WI | Primary |
| Nurse Practitioner | 363L00000X | 3195-033 | WI | |
| Registered Nurse | 163W00000X | 107505-030 | WI |
Addresses
Primary practice location
N2919 Cty Hwy QQ
Waupaca, WI 54981
Mailing address
N2919 Cty Hwy QQ
Waupaca, WI 54981
Phone (715) 258-2108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3195 | Other | WI | WI STATE LICENSE |
Other names 1
- Mary M. Beatty
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107505-030 | WI | MD | Registered Nurse |
| 3195 | WI | MD | Physician Assistant |
| 3195-033 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1053505362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2919 CTY HWY QQ",
"city": "WAUPACA",
"state": "WI",
"postal_code": "54981",
"telephone_number": "715-258-2108",
"fax_number": "715-942-2199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N2919 CTY HWY QQ",
"city": "WAUPACA",
"state": "WI",
"postal_code": "54981",
"telephone_number": "715-258-2108",
"fax_number": "715-942-2199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATTY-ROLOFF",
"first_name": "MARY",
"middle_name": "M.",
"credential": "APNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-29",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "3195",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "3195-033",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "107505-030",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI STATE LICENSE",
"identifier": "3195",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "BEATTY",
"middle_name": "M.",
"credential": "APNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waupaca, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.