Individual provider Active NPI

Mary Schroeder, CNM

  • Advanced Practice Midwife
  • San Diego, CA
National Provider Identifier
1164431664
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
CNMW 1617 Issued in CA
Practice address
2929 Health Center Dr
San Diego, CA 92123-2762
Phone
(858) 499-2600
NPI assigned
Aug 5, 2006
Last updated
Sep 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X CNMW 1617 CA Primary

Addresses

Primary practice location

2929 Health Center Dr
San Diego, CA 92123-2762

Mailing address

1405 San Elijo Ave
Cardiff by the Sea, CA 92007-2419
Phone (760) 632-0816

Other practice location 1

1130 2nd St
Encinitas, CA 92024-5008
Phone (760) 943-9994

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050329000447 CA Practitioner - Certified Nurse Midwife (CNM) 4486600822 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
CNMW 1617CAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 29, 2022 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jan 13, 2020 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jan 13, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 29, 2022 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

2929 Health Center Dr
San Diego, CA 92123
Phone (858) 939-6531

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1164431664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 SAN ELIJO AVE",
            "city": "CARDIFF BY THE SEA",
            "state": "CA",
            "postal_code": "920072419",
            "telephone_number": "760-632-0816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232762",
            "telephone_number": "858-499-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 2nd St",
            "address_purpose": "LOCATION",
            "city": "Encinitas",
            "state": "CA",
            "postal_code": "920245008",
            "country_code": "US",
            "telephone_number": "760-943-9994",
            "fax_number": "760-943-1661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHROEDER",
        "first_name": "MARY",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-09-26",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "CNMW 1617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.