NPIMap

Individual provider Active NPI

Mary E Smith

  • Family Nurse Practitioner
  • Phoenix, NY
National Provider Identifier
1477031342
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
343417 Issued in NY
Practice address
7 Bridge St
Phoenix, NY 13135-1906
Phone
(315) 695-4700
Fax
(315) 695-4706
NPI assigned
Aug 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 343417 NY Primary

Addresses

Primary practice location

7 Bridge St
Phoenix, NY 13135-1906

Mailing address

61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6569

Other practice location 1

61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6569

Other names 1

  • Mary E Shaben Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180912001681 NY Practitioner - Nurse Practitioner 9335499375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of Ny Upstate Medical University, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Oswego County Health Services, Inc.Group PAC ID 8426961541, 37 clinicians

Practice addresses (Care Compare)

7 Bridge St
Phoenix, NY 13135-1906
Phone (315) 695-4700

Hospital & facility affiliations

  • Oswego Hospital Hospital, Oswego, NY, CCN 330218

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Oswego County Health Services, Inc. CurrentSince Jul 28, 2018 Accepting new patients

Locations

3045 East Ave
Ste G400
Central Square, NY 13036
Phone (315) 675-9200

510 S 4th St
Ste 600
Fulton, NY 13069
Phone (315) 598-4790

5856 Scenic Ave
Mexico, NY 13114
Phone (315) 963-4133

120 E 1st St
Oswego, NY 13126
Phone (315) 342-0880

7 Bridge St
Phoenix, NY 13135
Phone (315) 695-4100

61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274

Interoperability endpoints

  • Direct secure messaging: mary.smith@nochsi.directbygreenway.com

Organizations & group practices 13

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.

View all 13

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": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1477031342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 DELANO ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131421400",
            "telephone_number": "315-298-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 BRIDGE ST",
            "city": "PHOENIX",
            "state": "NY",
            "postal_code": "131351906",
            "telephone_number": "315-695-4700",
            "fax_number": "315-695-4706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "61 Delano St",
            "address_purpose": "LOCATION",
            "city": "Pulaski",
            "state": "NY",
            "postal_code": "131421400",
            "country_code": "US",
            "telephone_number": "315-298-6569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARY",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-02",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "343417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SHABEN",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, NY

Sources for this page

Verify at the official NPI Registry.