NPIMap

Individual provider Active NPI

Mary Mancuso Hearod, N.P.

  • Family Nurse Practitioner
  • Lake Charles, LA
National Provider Identifier
1144760414
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP09122 Issued in LA
Practice address
2770 3Rd Ave Ste 345
Lake Charles, LA 70601-8994
Phone
(337) 494-4785
Fax
(337) 494-4786
NPI assigned
Mar 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP09122 LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 345
Lake Charles, LA 70601-8994

Mailing address

PO Box 122623
Dept 2623
Dallas, TX 75312-2623
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
AP09122OtherLASTATE MEDICAL LICENSE
2439740MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20170413000562 LA Practitioner - Nurse Practitioner 0345526984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health Center of Swla 9 clinicians

Practice addresses (Care Compare)

2770 3Rd Ave
Suite 345
Lake Charles, LA 70601-8994
Phone (337) 494-4785

Hospital & facility affiliations

  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
  • West Calcasieu Cameron Hospital Hospital, Sulphur, LA, CCN 190013
  • Beauregard Memorial Hospital Hospital, Deridder, LA, CCN 190050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP09122LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Digestive Health Center of Swla CurrentSince Mar 24, 2017 Accepting new patients
Southwest Louisiana Hospital Association Inc CurrentSince Oct 30, 2022 Accepting new patients

Locations

2615 Enterprise Blvd
Ste B
Lake Charles, LA 70601
Phone (337) 480-8900

2770 3rd Ave
Ste 345
Lake Charles, LA 70601
Phone (337) 494-4785

Interoperability endpoints

  • Direct secure messaging: mhearod5281964@direct.casso.us.com

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 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": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1144760414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122623",
            "address_2": "DEPT 2623",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122623",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE STE 345",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018994",
            "telephone_number": "337-494-4785",
            "fax_number": "337-494-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEAROD",
        "first_name": "MARY",
        "middle_name": "MANCUSO",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP09122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "AP09122",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2439740",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.