Active NPI
Mary M McCormack, RD, LDN
- Registered Dietitian
- Fort Myers, FL
National Provider Identifier
1104978659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND86
- Practice address
- 12458 McGregor Woods Cir
Fort Myers, FL 33908-2459 - Phone
- (239) 454-4466
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND86 | FL | Primary |
Addresses
Primary practice location
12458 McGregor Woods Cir
Fort Myers, FL 33908-2459
Mailing address
12458 McGregor Woods Cir
Fort Myers, FL 33908-2459
Phone (239) 454-4466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070517000080 | FL | Practitioner - Registered Dietitian Or Nutrition Professional | 6406803345 | Practice locations: Fort Myers, FL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221609600000",
"number": "1104978659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12458 MCGREGOR WOODS CIR",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339082459",
"telephone_number": "239-454-4466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12458 MCGREGOR WOODS CIR",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339082459",
"telephone_number": "239-454-4466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMACK",
"first_name": "MARY",
"middle_name": "M",
"credential": "RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2008-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND86",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.