NPIMap

Individual provider Active NPI

Mary Shannon Clow Becker, M.D.

  • Family Medicine Physician
  • Craig, CO
National Provider Identifier
1457649808
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
CO50848 Issued in CO
Practice address
595 Russell St
Craig, CO 81625-1920
Phone
(970) 826-0911
Fax
(970) 826-0910
NPI assigned
Jul 19, 2011
Last updated
Jul 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CO50848 CO Primary

Addresses

Primary practice location

595 Russell St
Craig, CO 81625-1920

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-4128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140211000269 CO Practitioner - Family Practice 9537398714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yampa Valley Medical CenterGroup PAC ID 5890685689, 128 clinicians

Practice addresses (Care Compare)

595 Russell St
Craig, CO 81625-1920
Phone (970) 824-1020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
CO50848COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yampa Valley Medical Center Current Accepting new patients
Yampa Valley Medical Center CurrentSince Aug 1, 2014 Accepting new patients
Yampa Valley Medical Center CurrentSince Aug 1, 2014 Accepting new patients

Locations

595 Russell St
Craig, CO 81625
Phone (970) 824-1020

651 Yampa Ave
Craig, CO 81625
Phone (970) 824-1020

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

1024 Central Park Dr
Steamboat Springs, CO 80487
Phone (970) 824-1322

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1457649808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4128",
            "fax_number": "970-490-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 RUSSELL ST",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816251920",
            "telephone_number": "970-826-0911",
            "fax_number": "970-826-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "MARY SHANNON",
        "middle_name": "CLOW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-19",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "CO50848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Craig, CO

Sources for this page

Verify at the official NPI Registry.