Active NPI
Mary Mora, MD
- Pediatrics Physician
- Lansing, MI
National Provider Identifier
1083723977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 043750
- Practice address
- 3937 Patient Care Dr
Lansing, MI 48911 - Phone
- (517) 394-6484
- Fax
- (517) 394-7785
- NPI assigned
- Aug 30, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 043750 | MI | Primary |
Addresses
Primary practice location
3937 Patient Care Dr
Lansing, MI 48911
Mailing address
3937 Patient Care Dr
Lansing, MI 48911
Phone (517) 394-6484
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1200190 | Other | MI | PHP |
| 201963697 | Other | MI | COMMERCIAL INS |
| 1270190 | Other | MI | COMMERCIAL INSURANCE |
| 5817732 | Other | MI | COMMERCIAL |
| 0C313191 | Other | MI | BCN |
| 4711314 | Medicaid | MI | |
| 0C31319 | Other | MI | BCBS |
| MM043750 | Other | MI | COMMERCIAL |
| P58952 | Other | MI | BCN |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043750 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1083723977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3937 PATIENT CARE DR",
"city": "LANSING",
"state": "MI",
"postal_code": "48911",
"telephone_number": "517-394-6484",
"fax_number": "517-394-7785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3937 PATIENT CARE DR",
"city": "LANSING",
"state": "MI",
"postal_code": "48911",
"telephone_number": "517-394-6484",
"fax_number": "517-394-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "MARY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "043750",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP",
"identifier": "1200190",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL INS",
"identifier": "201963697",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL INSURANCE",
"identifier": "1270190",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL",
"identifier": "5817732",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCN",
"identifier": "0C313191",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4711314",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0C31319",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL",
"identifier": "MM043750",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCN",
"identifier": "P58952",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.