Individual provider Active NPI

Mary Rose Loughran, PA-C

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1396502902
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4422 3Rd Ave BLDG Mills
Bronx, NY 10457-2545
Phone
(718) 960-6127
NPI assigned
Feb 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4422 3Rd Ave BLDG Mills
Bronx, NY 10457-2545

Mailing address

142 Surrey CT
Ramsey, NJ 07446-1267
Phone (201) 574-5776

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
I20240613003609 NY Practitioner - Physician Assistant 1254874696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SBH Physicians PCGroup PAC ID 3072798941, 178 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (718) 960-6205

2016 Bronxdale Ave
Bronx, NY 10462-3388
Phone (718) 822-1515

4422 3Rd Ave
Bronx, NY 10457-2545
Phone (718) 960-6214

4487 3Rd Ave
Bronx, NY 10457-1526
Phone (718) 960-6392

Hospital & facility affiliations

  • St Barnabas Hospital Hospital, Bronx, NY, CCN 330399

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SBH Physicians, PC Physician Assistant CurrentSince May 4, 2024 Accepting new patients
Quarry Road Emergency Services P.C. Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

4422 3rd Ave
Bldg Mls
Bronx, NY 10457
Phone (718) 960-6127

4422 3rd Ave
Bronx, NY 10457
Phone (718) 960-3917

Networks

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

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.

Hospital & facility affiliations 1

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": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1396502902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 SURREY CT",
            "city": "RAMSEY",
            "state": "NJ",
            "postal_code": "074461267",
            "telephone_number": "201-574-5776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 3RD AVE BLDG MILLS",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104572545",
            "telephone_number": "718-960-6127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOUGHRAN",
        "first_name": "MARY ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.