Individual provider Active NPI

Mary O'Doherty Sadler, DPT

  • Physical Therapist
  • Winston Salem, NC
National Provider Identifier
1053890590
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18192 Issued in NC
Practice address
111 Hanestown CT Ste 151
Winston Salem, NC 27103-1749
Phone
(336) 765-9350
Fax
(336) 760-4255
NPI assigned
Aug 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 18192 NC Primary

Addresses

Primary practice location

111 Hanestown CT Ste 151
Winston Salem, NC 27103-1749

Mailing address

111 Hanestown CT Ste 151
Winston Salem, NC 27103-1749
Phone (336) 765-9350

Other identifiers 1

IdentifierTypeStateIssuer
W056698870OtherNCAETNA

Other names 1

  • Dr. Mary Catherine O'Doherty Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220321001171 NC Practitioner - Physical Therapist in Private Practice 9032504550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1501 W Yamato Rd
Suite 200
Boca Raton, FL 33431-4438

PO Box
Belfast, ME 04915

Merit-based Incentive Payment System (MIPS)

Final score
88.25 of 100Reported as group
Quality
82.32
Promoting interoperability
100
Improvement activities
40
Cost
78.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18192NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Uwh of the Carolinas, PLLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

445 Pineview Dr
Ste 110
Kernersville, NC 27284
Phone (336) 993-4532

1806 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 768-3632

111 Hanestown Ct
#151
Winston Salem, NC 27103
Phone (919) 334-0150

Interoperability endpoints

  • Direct secure messaging: mary.sadler.1@7773.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1053890590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HANESTOWN CT STE 151",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031749",
            "telephone_number": "336-765-9350",
            "fax_number": "336-760-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HANESTOWN CT STE 151",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031749",
            "telephone_number": "336-765-9350",
            "fax_number": "336-760-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADLER",
        "first_name": "MARY",
        "middle_name": "O'DOHERTY",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-07",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "18192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "W056698870",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "O'DOHERTY",
            "middle_name": "CATHERINE",
            "prefix": "DR.",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.