Mary Kathleen Flanders, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0110002066 Issued in VA

Practice address

1235 Viking Topaz CT
Westfield, IN 46074-7622

Phone

(617) 821-6870

NPI assigned

Jan 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1194703546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 MAGAZINE ST",
            "address_2": "#5",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393942",
            "telephone_number": "617-821-6870",
            "fax_number": "617-975-0989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 VIKING TOPAZ CT",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460747622",
            "telephone_number": "617-821-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANDERS",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "AP2121",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110002066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010203155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0139",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Westfield, IN
• Providers in Westfield, IN by specialty
• Surgical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.