Mary Elizabeth Connell, MD
Individual provider Active NPI Internal Medicine Physician · Avon, IN
NPI 1396194403 · NPPES record last updated Jun 27, 2019
Key facts
- NPI
- 1396194403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 01082123A (IN)
- Practice address
- 1111 Ronald Reagan Pkwy
Avon, IN 46123-7085 - Phone
- (317) 217-3649
- NPI assigned
- Jun 9, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Saint Louis University School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Select Physical Therapy Holdings Inc
Franklin Hospital District
Practice addresses (Care Compare)
1104 W Main St
Benton, IL 62812-1565
Phone (618) 439-3399
201 Bailey LN
Benton, IL 62812-1969
Phone 6184393161332
Hospital & facility affiliations
- Mederi Caretenders
- LHC-Illinois Home Health Care
- Franklin Hospital
- Herrin Hospital
- Good Samaritan Regional HLTH Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210211001451 | IL | Practitioner - Internal Medicine | 7517259112 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01082123A | IN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Franklin Hospital District | Internal Medicine | Current |
Accepting new patients |
| Franklin Hospital District | Current |
Accepting new patients | |
| Franklin Hospital District | Current | Accepting new patients | |
| Franklin Hospital District | Past | Accepting new patients |
Locations
201 Bailey Ln
Fl 3
Benton, IL 62812
Phone (618) 435-9760
201 Bailey Ln
Benton, IL 62812
Phone (618) 438-3113
Interoperability endpoints
- maryconnell@franklinhhc.allscriptsdirect.net
- mconnell@yourcarecommunity.org
- https://fhir.yourcareuniverse.net/tenant/c680de42-53d4-410c-a755-e5a226565d34
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 01082123A | IN | Yes |
Addresses
Primary practice location
1111 Ronald Reagan Pkwy
Avon, IN 46123-7085
Mailing address
250 N Shadeland Ave # 200
Indianapolis, IN 46219-4959
Phone (317) 962-4942
Other practice location 1
340 W 10th Street
Indiana University School of Medicine
Indianapolis, IN 46202
Phone (317) 274-3772
Other names
- Mary Elizabeth Dougherty
Other providers in Avon, IN
- Comprehensive Neurologic Services PC
- Comprehensive Pain and Spine Specialists LLC
- Comprehensive Pain and Spine Specialists LLC
- Steven G Conant
- Connect Hearing
- Constant Comfort Home Care
- Jessica Everingham Cooper
- Cordant Pharmacy Indiana LLC
- Core Wellness Solutions LLC
- Kristina Corn
All providers in Avon, IN · Internal Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.