Mary Kelley McCormick, PA-XC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60471575 Issued in WA

Practice address

201 16TH Ave E
Seattle, WA 98112-5226

Phone

(206) 326-3000

NPI assigned

Mar 21, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MT

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

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SCL Health Medical Group - Billings LLCGroup PAC ID 9638491574, 291 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health St Vincent Regional Hospital Hospital, Billings, MT, CCN 270049

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmccormick87994@fhsce.catholichealth.net
• Direct secure messaging: mmccormick230265@ghc.direct-ci.net

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.

• SCL Health Medical Group - Billings LLC

  dba St Vincent Healthcare

  • Clinic/Center
  • Billings, MT
  • NPI 1508289703
  Medicare reassignment Care Compare group NPD (past)
• SCL Health Medical Group - Billings, LLC

  dba Billings - DPP (Diabetes Prevention Program)

  • Endocrinology, Diabetes & Metabolism Physician
  • Billings, MT
  • NPI 1003701558
  NPD
• SCL Health Medical Group - Billings, LLC

  dba Heights Clinic - Walk In

  • General Practice Physician
  • Billings, MT
  • NPI 1447866538
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• SCL Health Montana

  dba Intermountain Health St Vincent Regional Hospital

  • General Acute Care Hospital
  • Billings, MT
  • NPI 1083655997
  Care Compare affiliation
• St. Vincent Healthcare

  • General Acute Care Hospital
  • Billings, MT
  • NPI 1396916276
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1477724060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125226",
            "telephone_number": "206-326-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125226",
            "telephone_number": "206-326-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1344 Wintergreen Ln NE",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981105147",
            "country_code": "US",
            "telephone_number": "206-855-7600",
            "fax_number": "253-534-7099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "MARY",
        "middle_name": "KELLEY",
        "credential": "PA-XC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-21",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60471575",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "504",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA 9106243",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2038846",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "504",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmccormick87994@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1344 Wintergreen Ln NE",
            "city": "Bainbridge Island",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981105147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "201 16th Ave E",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joshua Jamar McCormick
• Kathryn Ann McCormick, L.M.F.T., L.M.P.
• Keyndra Suzanne McCormick, LMT
• Kinsey A McCormick, MD
• Madison McCormick
• Matthew J McCormick, MD
• Meg Bladt McCormick, LMHCA
• Michael McCormick, CDP
• Nicole Villarreal McCormick, MSW, LAC
• Riley Morgan McCormick, LMHC

• Physician Assistant in Seattle, WA
• Providers in Seattle, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.