Individual provider Active NPI

Mary Coffey Greist, MD

  • Dermatopathology Physician
  • Indianapolis, IN
National Provider Identifier
1306933858
Registry record updated May 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
01024873 Issued in IN
Practice address
6820 Parkdale Place
Suite 211
Indianapolis, IN 46254-6600
Phone
(317) 329-7050
Fax
(317) 328-6809
NPI assigned
Oct 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X 01024873 IN Primary
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X 01024873 IN

Addresses

Primary practice location

6820 Parkdale Place
Suite 211
Indianapolis, IN 46254-6600

Mailing address

6820 Parkdale Place
Suite 211
Indianapolis, IN 46254-6600
Phone (317) 329-7050

Other identifiers 2

IdentifierTypeStateIssuer
000000085208OtherINANTHEM
100060500MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01024873INMDDermatopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Creek Dermatology Clinical & Laboratory Dermatological Immunology CurrentSince Aug 1, 2018 Accepting new patients
Major Hospital Past Accepting new patients

Locations

6820 Parkdale Pl
Ste 211
Indianapolis, IN 46254
Phone (317) 329-7050

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274832000000",
    "number": "1306933858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6820 PARKDALE PLACE",
            "address_2": "SUITE 211",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462546600",
            "telephone_number": "317-329-7050",
            "fax_number": "317-328-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6820 PARKDALE PLACE",
            "address_2": "SUITE 211",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462546600",
            "telephone_number": "317-329-7050",
            "fax_number": "317-328-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREIST",
        "first_name": "MARY",
        "middle_name": "COFFEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2010-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "IN",
            "license": "01024873",
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "IN",
            "license": "01024873",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000085208",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100060500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; 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.