Mary J. Baker, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201350028NP Issued in OR

Practice address

21990 Highway 62
Shady Cove, OR 97539-9717

Phone

(541) 878-2022

Fax

(541) 878-1498

NPI assigned

Feb 13, 2013

Last updated

Aug 12, 2020By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1053650960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975390428",
            "telephone_number": "541-878-2022",
            "fax_number": "541-878-1498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21990 HIGHWAY 62",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975399717",
            "telephone_number": "541-878-2022",
            "fax_number": "541-878-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "MARY",
        "middle_name": "J.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-13",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201350028NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500655794",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neil Dale Arnspiger
• Robert Russell Bennett, D.C.
• Philip Broesamle
• Central Drug Store Inc (Shady Cove Pharmacy)
• Paige Chick
• Casey Dean Clingan, DMD

• Family Nurse Practitioner in Shady Cove, OR
• Providers in Shady Cove, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.

Verify at the official NPI Registry.