Individual provider Active NPI

Mary Gertrude Barnes, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Hobart, OK
National Provider Identifier
1104165067
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0064303 Issued in OK
Practice address
429 W Elm St
Hobart, OK 73651-1615
Phone
(580) 726-5088
NPI assigned
Feb 12, 2013
Last updated
Oct 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R0064303 OK Primary

Addresses

Primary practice location

429 W Elm St
Hobart, OK 73651-1615

Mailing address

429 W Elm St
Hobart, OK 73651-1615
Phone (580) 726-5088

Other identifiers 2

IdentifierTypeStateIssuer
R0064303OtherOKOKLAHOMA BOARD OF NURSING
200478250AMedicaidOK

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130503000457 OK Practitioner - Nurse Practitioner 4789821075 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mangum City Hospital AuthorityGroup PAC ID 6305119942, 10 clinicians

Practice addresses (Care Compare)

1 Wickersham St
Mangum, OK 73554-9117
Phone (580) 782-3353

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R0064303OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mangum City Hospital Authority CurrentSince Aug 20, 2018 Accepting new patients
Mangum City Hospital Authority CurrentSince Aug 20, 2018 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1 Wickersham St
Mangum, OK 73554
Phone (580) 782-3353

118 S Louis Tittle Ave
Mangum, OK 73554
Phone (580) 782-2000

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1104165067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 W ELM ST",
            "city": "HOBART",
            "state": "OK",
            "postal_code": "736511615",
            "telephone_number": "580-726-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 W ELM ST",
            "city": "HOBART",
            "state": "OK",
            "postal_code": "736511615",
            "telephone_number": "580-726-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARNES",
        "first_name": "MARY",
        "middle_name": "GERTRUDE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-12",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0064303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA BOARD OF NURSING",
            "identifier": "R0064303",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200478250A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, OK

Sources for this page

Verify at the official NPI Registry.