Active NPI
Mary P Gospodarek, APNP
- Nurse Practitioner
- Two Rivers, WI
National Provider Identifier
1386683563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1539
- Practice address
- 2219 Garfield St
Two Rivers, WI 54241 - Phone
- (920) 793-2281
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1539 | WI | Primary |
Addresses
Primary practice location
2219 Garfield St
Two Rivers, WI 54241
Mailing address
2219 Garfield St
Two Rivers, WI 54241-2416
Phone (920) 793-2281
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43904900 | Medicaid | WI |
Other names 1
- Mary P Shimek
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mgospodarek59437@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1539 | WI | MD | Nurse Practitioner |
Interoperability endpoints
- mgospodarek59437@direct.myadvocateaurora.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637539200000",
"number": "1386683563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2219 GARFIELD ST",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "542412416",
"telephone_number": "920-793-2281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2219 GARFIELD ST",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "54241",
"telephone_number": "920-793-2281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOSPODAREK",
"first_name": "MARY",
"middle_name": "P",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-05",
"last_updated": "2021-11-22",
"certification_date": "2021-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "1539",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43904900",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mgospodarek59437@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "2219 Garfield St",
"city": "Two Rivers",
"state": "WI",
"country_code": "US",
"postal_code": "54241",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "2219 Garfield St",
"city": "Two Rivers",
"state": "WI",
"country_code": "US",
"postal_code": "54241",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "MARY",
"last_name": "SHIMEK",
"middle_name": "P",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Two Rivers, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.