NPIMap

Individual provider Active NPI

Mary Ann Leary, DO

  • Family Medicine Physician
  • Eagleville, PA
National Provider Identifier
1104810860
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS008302L Issued in PA
Practice address
3301 Ridge Pike
Eagleville, PA 19403-1411
Phone
(610) 539-9100
Fax
(610) 539-6570
NPI assigned
Sep 8, 2005
Last updated
Mar 25, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS008302L PA Primary

Addresses

Primary practice location

3301 Ridge Pike
Eagleville, PA 19403-1411

Mailing address

1 W Elm St
Suite 100
Conshohocken, PA 19428-2007
Phone (610) 567-6967

Other identifiers 1

IdentifierTypeStateIssuer
0015040010005MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101027000171 PA Practitioner - Family Practice 0446444160 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penn Medicine-PmaGroup PAC ID 6507269370, 55 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

13 Armand Hammer Blvd
Suite 100
Pottstown, PA 19464-5067
Phone (610) 323-3100

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Penn Medicine-Pma CurrentSince Jun 26, 2023 Accepting new patients
Penn Medicine-Pma Current Accepting new patients
Suburban Medical Group LLC Family Medicine CurrentSince Oct 1, 2015 Accepting new patients
East Norriton Physicians Services Family Medicine Past Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Family Medicine Past Accepting new patients

Locations

150 Monument Rd
Ste 400
Bala Cynwyd, PA 19004
Phone (610) 747-3470

2701 DeKalb Pike
Fl 2
East Norriton, PA 19401
Phone (610) 275-1028

13 Armand Hammer Blvd
Ste 100
Pottstown, PA 19464
Phone (610) 323-3100

Interoperability endpoints

  • FHIR API: https://ssproxy.pennhealth.com/PRD-FHIR/api/FHIR/R4/

Organizations & group practices 5

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 11

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1104810860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W ELM ST",
            "address_2": "SUITE 100",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282007",
            "telephone_number": "610-567-6967",
            "fax_number": "610-567-6955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 RIDGE PIKE",
            "city": "EAGLEVILLE",
            "state": "PA",
            "postal_code": "194031411",
            "telephone_number": "610-539-9100",
            "fax_number": "610-539-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "MARY ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-08",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS008302L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015040010005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagleville, PA

Sources for this page

Verify at the official NPI Registry.