Individual provider Active NPI

Mary Becker, PA

  • Physician Assistant
  • Mineola, NY
National Provider Identifier
1336648880
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
P09459 Issued in NY
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 428-9109
NPI assigned
Feb 9, 2018
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P09459 NY Primary
Family Medicine Physician 207Q00000X P09459 NY

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

259 1St St
Mineola, NY 11501-3957
Phone (516) 428-9109

Other practice location 1

16 Van Cott Rd Ste 2E
Deer Park, NY 11729-6519
Phone (631) 274-0777

Other practice location 2

16 Van Cott Rd Ste 2E
Deer Park, NY 11729-6519
Phone (631) 274-0777

Other names 1

  • Mary Wolter Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180425001897 NY Practitioner - Physician Assistant 6901160019 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

1436 Union Tpke
New Hyde Park, NY 11040-1761
Phone (516) 360-3631

2640 Merrick Rd
Bellmore, NY 11710-5715
Phone (516) 537-9064

3631 Hempstead Tpke
63A
Levittown, NY 11756-1315
Phone (516) 537-9063

377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061

50 E Jericho Tpke
Mineola, NY 11501-3141
Phone (516) 399-3068

683 Sunrise Hwy
Lynbrook, NY 11563-3246
Phone (516) 441-2155

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
P09459NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Family Medicine CurrentSince Oct 15, 2023 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Winthrop Community Medical Affiliates, P.C. CurrentSince Mar 10, 2018 Accepting new patients

Locations

700 Hicksville Rd
Ste 204
Bethpage, NY 11714
Phone (516) 576-5812

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

300 Community Dr
Manhasset, NY 11030

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: mary.wolter@ghuc.eclinicaldirectplus.com

Organizations & group practices 5

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": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1336648880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-428-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-428-9109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Van Cott Rd Ste 2E",
            "address_purpose": "LOCATION",
            "city": "Deer Park",
            "state": "NY",
            "postal_code": "117296519",
            "country_code": "US",
            "telephone_number": "631-274-0777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16 Van Cott Rd Ste 2E",
            "address_purpose": "LOCATION",
            "city": "Deer Park",
            "state": "NY",
            "postal_code": "117296519",
            "country_code": "US",
            "telephone_number": "631-274-0777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BECKER",
        "first_name": "MARY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "P09459",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "P09459",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WOLTER",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.