Individual provider Active NPI

Mary McComis, MD

  • Obstetrics & Gynecology Physician
  • Waukesha, WI
National Provider Identifier
1104890722
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
34707 Issued in WI
Practice address
721 American Ave, Ste 304
Waukesha, WI 53188
Phone
(262) 549-2229
Fax
(262) 549-1657
NPI assigned
Feb 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 34707 WI Primary

Addresses

Primary practice location

721 American Ave, Ste 304
Waukesha, WI 53188

Mailing address

721 American Ave, Ste 304
Waukesha, WI 53188
Phone (262) 549-2229

Other identifiers 1

IdentifierTypeStateIssuer
31961200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100604001154 WI Practitioner - Obstetrics/Gynecology 7719899459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Rush Medical College of Rush University, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Women'S Health Care, SCGroup PAC ID 3870648272, 6 clinicians

Practice addresses (Care Compare)

721 American Ave
Suite 304
Waukesha, WI 53188-5071
Phone (262) 549-2229

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34707WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Health Care, SC CurrentSince Jan 1, 2017 Accepting new patients

Locations

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

721 American Ave
Ste 304
Waukesha, WI 53188
Phone (262) 549-2229

Interoperability endpoints

  • Direct secure messaging: mmccomis10532@direct.phci.org

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1104890722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 AMERICAN AVE, STE 304",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53188",
            "telephone_number": "262-549-2229",
            "fax_number": "262-549-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 AMERICAN AVE, STE 304",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53188",
            "telephone_number": "262-549-2229",
            "fax_number": "262-549-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOMIS",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "34707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31961200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.