NPIMap

Individual provider Active NPI

Mary S Michener, MD

  • Family Medicine Physician
  • Winona, MN
National Provider Identifier
1124038724
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38452 Issued in MN
Practice address
859 Mankato Avenue
Winona Clinic LTD
Winona, MN 55987
Phone
(507) 454-3680
Fax
(507) 457-7672
NPI assigned
Aug 8, 2006
Last updated
Dec 13, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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 38452 MN Primary

Addresses

Primary practice location

859 Mankato Avenue
Winona Clinic LTD
Winona, MN 55987

Mailing address

859 Mankato Avenue
Winona Clinic LTD
Winona, MN 55987
Phone (507) 454-3680

Other identifiers 1

IdentifierTypeStateIssuer
636227300MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20080408000502 MN Practitioner - Family Practice 8224115795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Winona Health ServicesGroup PAC ID 8527977420, 160 clinicians

Practice addresses (Care Compare)

855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3650

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Winona Health Services CurrentSince Oct 1, 2009 Accepting new patients
Winona Health Services Past Accepting new patients

Locations

420 E Sarnia St
Winona, MN 55987
Phone (507) 454-3680

420 E Sarnia St
Ste 2500
Winona, MN 55987

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

859 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1124038724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVENUE",
            "address_2": "WINONA CLINIC LTD",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVENUE",
            "address_2": "WINONA CLINIC LTD",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHENER",
        "first_name": "MARY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "38452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "636227300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.