Individual provider Active NPI

Mary Ann Schultz, PA-C

  • Physician Assistant
  • Dakota Dunes, SD
National Provider Identifier
1417048455
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0662 Issued in SD
Practice address
705 N Sioux Point Rd Ste 100
Dakota Dunes, SD 57049-5091
Phone
(605) 217-5500
Fax
(605) 217-5515
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001829 IA
Physician Assistant 363A00000X 1396 NE
Physician Assistant 363A00000X 0662 SD Primary

Addresses

Primary practice location

705 N Sioux Point Rd Ste 100
Dakota Dunes, SD 57049-5091

Mailing address

705 Sioux Point Road
Suite 100
Dakota Dunes, SD 57049-5091
Phone (605) 217-5500

Other practice location 1

455 N Sioux Point Rd
Dakota Dunes, SD 57049-5327
Phone (605) 217-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, SD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080117000279 IA Practitioner - Physician Assistant 8224063151 Reassigns benefits to 1 organization
I20100624000826 SD Practitioner - Physician Assistant 8224063151 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cnos PCGroup PAC ID 4284548942, 98 clinicians

Practice addresses (Care Compare)

575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312
Phone (605) 217-2667

705 N Sioux Point Rd
Suite 100
Dakota Dunes, SD 57049-5091
Phone (605) 217-2667

Hospital & facility affiliations

  • St Lukes Regional Medical Center Hospital, Sioux City, IA, CCN 160146
  • Buena Vista Regional Medical Center Hospital, Storm Lake, IA, CCN 161375
  • Pender Community Hospital Hospital, Pender, NE, CCN 281349
  • Floyd Valley Healthcare Hospital, Le Mars, IA, CCN 161368
  • Burgess Health Center Hospital, Onawa, IA, CCN 161359

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9841MNMDClinical Social Worker
001829IAMDSpeech-Language Pathologist
1396NEMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Cnos PC CurrentSince Jan 1, 2023 Accepting new patients

Locations

1301 W Main St
Lake City, IA 51449
Phone (712) 464-3171

5708 Sunnybrook Ct
Sioux City, IA 51106

2735 Outer Dr N
Sioux City, IA 51104
Phone (712) 224-5692

100 Hospital Dr
Pender, NE 68047
Phone (402) 385-3083

575 N Sioux Point Rd
North Sioux City, SD 57049
Phone (605) 217-2615

705 N Sioux Point Rd
Ste 100
North Sioux City, SD 57049
Phone (605) 217-5566

Interoperability endpoints

  • Direct secure messaging: maryschultz@cnos.allscriptsdirect.net
  • Direct secure messaging: mschultz128393@direct.unitypoint.org

Organizations & group practices 3

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 5

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417048455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 SIOUX POINT ROAD",
            "address_2": "SUITE 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495091",
            "telephone_number": "605-217-5500",
            "fax_number": "605-217-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N SIOUX POINT RD STE 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495091",
            "telephone_number": "605-217-5500",
            "fax_number": "605-217-5515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 N Sioux Point Rd",
            "address_purpose": "LOCATION",
            "city": "Dakota Dunes",
            "state": "SD",
            "postal_code": "570495327",
            "country_code": "US",
            "telephone_number": "605-217-7000",
            "fax_number": "605-217-7015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001829",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1396",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dakota Dunes, SD

Sources for this page

Verify at the official NPI Registry.