Individual provider Active NPI

Mary Eileen McCormack, DO

  • Obstetrics & Gynecology Physician
  • Crown Point, IN
National Provider Identifier
1104939958
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
02001585A Issued in IN
Practice address
800 W Burrell Dr
Crown Point, IN 46307-8898
Phone
(219) 663-9913
Fax
(219) 663-9923
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 02001585A IN
Obstetrics & Gynecology Physician 207V00000X 02001585A IN Primary

Addresses

Primary practice location

800 W Burrell Dr
Crown Point, IN 46307-8898

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

12750 St Francis Dr
Crown Point, IN 46307-0264
Phone (219) 757-6331

Other identifiers 4

IdentifierTypeStateIssuer
000000088456OtherINANTHEM BC/BS
160057113OtherINRAIL ROAD MEDICARE
200017580AMedicaidIN
M47140040OtherINMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmccormack83137@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20140313000384 IN Practitioner - Obstetrics/Gynecology 1456581495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Midwestern University, Chicago College of Osteopathic Med, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

12750 Saint Francis Dr
Crown Point, IN 46307-0264

150 W Washington St
Shelbyville, IN 46176-1236
Phone (317) 865-5904

1704 Lafayette Rd
Crawfordsville, IN 47933-1071

800 W Burrell Dr
Crown Point, IN 46307-8898
Phone (219) 663-9913

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02001585AINMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Feb 3, 2014 Accepting new patients
Franciscan Physician Network CurrentSince Feb 3, 2014 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1205 S Main St
Ste 205
Crown Point, IN 46307
Phone (219) 662-6538

12750 Saint Francis Dr
Crown Point, IN 46307
Phone (219) 738-2100

1201 S Main St
Crown Point, IN 46307
Phone (219) 738-2100

800 W Burrell Dr
Crown Point, IN 46307
Phone (219) 310-8828

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Organizations & group practices 2

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 6

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1104939958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W BURRELL DR",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078898",
            "telephone_number": "219-663-9913",
            "fax_number": "219-663-9923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12750 St Francis Dr",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463070264",
            "country_code": "US",
            "telephone_number": "219-757-6331",
            "fax_number": "219-757-6481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "MARY",
        "middle_name": "EILEEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "02001585A",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "02001585A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000088456",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "160057113",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200017580A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "M47140040",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmccormack83137@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1201 S Main St",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463078481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.