Individual provider Active NPI

Mary Beth Hogan, M.D.

  • Pediatric Allergy/Immunology Physician
  • Huntington, WV
National Provider Identifier
1174603104
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X
License
18282 Issued in WV
Practice address
1600 Medical Center Dr Ste 3500
Huntington, WV 25701-3655
Phone
(304) 691-1300
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Allergy/Immunology Physician 2080P0201X 12265 NV
Pediatric Allergy/Immunology Physician 2080P0201X 18282 WV Primary

Addresses

Primary practice location

1600 Medical Center Dr Ste 3500
Huntington, WV 25701-3655

Mailing address

1524 Pinto LN FL 3
Las Vegas, NV 89106-4195
Phone (702) 992-6868

Other practice location 1

1524 Pinto Ln Fl 3
Las Vegas, NV 89106-4195
Phone (702) 992-6868

Other identifiers 1

IdentifierTypeStateIssuer
0109785000MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marybeth.hogan@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Jul 22, 2019 Accepting new patients
University Physicians & Surgeons, Inc Family Medicine CurrentSince Jul 22, 2019 Accepting new patients

Locations

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

1448 10th Ave
Ste 304
Huntington, WV 25701
Phone (304) 691-6381

Interoperability endpoints

  • Direct secure messaging: mhogan18628@direct.umcsn.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.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1174603104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 PINTO LN FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064195",
            "telephone_number": "702-992-6868",
            "fax_number": "702-992-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 MEDICAL CENTER DR STE 3500",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013655",
            "telephone_number": "304-691-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1524 Pinto Ln Fl 3",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891064195",
            "country_code": "US",
            "telephone_number": "702-992-6868",
            "fax_number": "702-992-6860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOGAN",
        "first_name": "MARY BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "NV",
            "license": "12265",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "WV",
            "license": "18282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0109785000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marybeth.hogan@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1600 Medical Center Dr Ste 3500",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257013655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.