Individual provider Active NPI

Mary Elizabeth Corgan, MSN APRN FNP-BC

  • Family Nurse Practitioner
  • Cape Girardeau, MO
National Provider Identifier
1255664280
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
125183 Issued in MO
Practice address
371 S Broadview St
Cape Girardeau, MO 63703-5761
Phone
(573) 334-6008
Fax
(573) 334-1713
NPI assigned
Sep 9, 2009
Last updated
Jul 26, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

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 125183 MO Primary

Addresses

Primary practice location

371 S Broadview St
Cape Girardeau, MO 63703-5761

Mailing address

371 S Broadview St
Cape Girardeau, MO 63703-5761
Phone (573) 334-6008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20120306000519 MO Practitioner - Nurse Practitioner 3173782471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 334-4822

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Missouri Hospital Physicians, LLC CurrentSince Jan 21, 2012 Accepting new patients

Locations

371 S Broadview St
Cape Girardeau, MO 63703
Phone (573) 331-6710

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

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.

Hospital & facility affiliations 2

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": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1255664280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 S BROADVIEW ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637035761",
            "telephone_number": "573-334-6008",
            "fax_number": "573-334-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 S BROADVIEW ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637035761",
            "telephone_number": "573-334-6008",
            "fax_number": "573-334-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORGAN",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "MSN APRN FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-09",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "125183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.