Mary Shenouda, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME165007 Issued in FL

Practice address

1615 SW Main Blvd
Lake City, FL 32025-1108

Phone

(386) 755-2785

Fax

(386) 755-1128

NPI assigned

Dec 14, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Ophthalmology

Education

Loyola University of Chicago, Stritch School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbia Eye Associates PAGroup PAC ID 7517950637, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mshenouda@ceapa.intellechartdirect.net
• FHIR API: https://app.meldrx.com/api/fhir/K8KD7A7C

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

• Columbia Eye Associates PA

  • Ophthalmology Physician
  • Lake City, FL
  • NPI 1295921096
  Medicare reassignment Care Compare group NPD
• Light of the World Eye Care, PLLC

  • Ophthalmology Physician
  • Sarasota, FL
  • NPI 1073463634
  Medicare reassignment NPD Authorized official
• Promedica Central Physicians

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1043270150

  Ophthalmology

  Medicare reassignment NPD
• Promedica Central Physicians

  • Durable Medical Equipment & Medical Supplies
  • Toledo, OH
  • NPI 1669068482
  NPD
• Reichert Eye Centers of N FL, PA

  • Ophthalmology Physician
  • Lake City, FL
  • NPI 1902835069
  NPD (past)
• Advanced Ophthalmology of Michiana LLC

  • Ophthalmology Physician
  • South Bend, IN
  • NPI 1548304876
  NPD (past)
• Advanced Ophthalmology of Michiana LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1962547984
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1104801976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 489",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320560489",
            "telephone_number": "386-755-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 SW MAIN BLVD",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320251108",
            "telephone_number": "386-755-2785",
            "fax_number": "386-755-1128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1252 Ralston Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Defiance",
            "state": "OH",
            "postal_code": "435121480",
            "country_code": "US",
            "telephone_number": "419-782-6588",
            "fax_number": "419-784-3622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHENOUDA",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01060074A",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "88852",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME165007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2713460",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Marie Shaughnessy, LPN
• Rebecca Anne Sheeder, O.D.
• Linda Sheehan-Foster, PA-C
• John Thomas Sheehan, PHARMD
• Rachel Dawne Shelley, B.S., ITDS
• Demetrius Sheppard
• Eva Sheppard
• Troy L Sheppard
• John Ronald Sherman, PTA
• Mary Shimko, CRNA

• Ophthalmology Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.