Individual provider Active NPI

Mary Ann Fore, R.N.C., C.N.M., M.S.

  • Women's Health Nurse Practitioner
  • Brownsville, TX
National Provider Identifier
1184627655
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
239542 Issued in TX
Practice address
1076 E Los Ebanos Blvd
Brownsville, TX 78520-9988
Phone
(956) 544-2001
Fax
(956) 546-4567
NPI assigned
May 27, 2005
Last updated
Jul 16, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 239542 TX Primary

Addresses

Primary practice location

1076 E Los Ebanos Blvd
Brownsville, TX 78520-9988

Mailing address

1076 E Los Ebanos Blvd
Brownsville, TX 78520-9988
Phone (956) 544-2001

Other identifiers 2

IdentifierTypeStateIssuer
81N053OtherTXBLUE CROSS
0900706-01MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101104000253 TX Practitioner - Nurse Practitioner 6002000932 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Master of Science, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
239542TXMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dagoberto Martinez, Mdpa CurrentSince Jul 20, 2010 Accepting new patients

Locations

1076 E Los Ebanos Blvd
Brownsville, TX 78520
Phone (956) 544-2001

3855 Southmost Rd
Brownsville, TX 78521
Phone (956) 544-2001

95 E Price Rd
Bldg A
Brownsville, TX 78521
Phone (956) 504-6080

Organizations & group practices 1

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437004800000",
    "number": "1184627655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1076 E LOS EBANOS BLVD",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785209988",
            "telephone_number": "956-544-2001",
            "fax_number": "956-546-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1076 E LOS EBANOS BLVD",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785209988",
            "telephone_number": "956-544-2001",
            "fax_number": "956-546-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORE",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "R.N.C., C.N.M., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2015-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "239542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "81N053",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0900706-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brownsville, TX

Sources for this page

Verify at the official NPI Registry.