Mary Susan Sander, C.N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP-05340 Issued in OH

Practice address

2726 Fulton Dr NW
Canton, OH 44718-3506

Phone

(330) 455-5011

Fax

(330) 588-7127

NPI assigned

Oct 27, 2005

Last updated

May 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 5

Other names 1

• Ms. Mary Susan Telloni Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Merit-based Incentive Payment System (MIPS)

Final score

88.59 of 100Reported as group

Quality

83.4

Promoting interoperability

100

Improvement activities

40

Cost

78.58

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Family Medicine Health & Wellness Center, Inc

  • Family Medicine Physician
  • Massillon, OH
  • NPI 1265459259
  NPD (past)
• Mercy Professional Care, LLC

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1902827876
  NPD (past)

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1073503322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183506",
            "telephone_number": "330-455-5011",
            "fax_number": "330-588-7127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2726 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183506",
            "telephone_number": "330-455-5011",
            "fax_number": "330-588-7127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDER",
        "first_name": "MARY",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "C.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "NP-05340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2179664",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00341076",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000492313",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMETOWN",
            "identifier": "1073503322",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AULTCARE",
            "identifier": "341773267G",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "TELLONI",
            "middle_name": "SUSAN",
            "prefix": "MS.",
            "credential": "C.N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Muhannad Samaan, M.D.
• Samantha Samblanet
• Yolanta Victoria Samuels, PHARMD
• Morgan Chermain Sanches
• Bailey Marie Sand
• Brittany Nicole Sanders, LPCC-S
• Lauri Sanders
• Lester Lamont Sanders
• Trarese Sanders
• Laura Sanderson, PT

• Nurse Practitioner in Canton, OH
• Providers in Canton, OH by specialty
• Nurse Practitioner in Ohio

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