Mary O Wunderlich, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085000332 Issued in IL

Practice address

325 Spring Street
Red Bud, IL 62278

Phone

(618) 282-3831

Fax

(618) 282-5476

NPI assigned

Dec 6, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Red Bud Illinois Hospital Company LLCGroup PAC ID 2466416821, 15 clinicians

Deaconess Illinois Red Bud Regional Hospital IncGroup PAC ID 9537531579, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Red Bud Regional Hospital Hospital, Red Bud, IL, CCN 141348

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.wunderlich.1@27782.direct.athenahealth.com

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.

• Deaconess Illinois Red Bud Regional Hospital Inc

  • Rural Health Clinic/Center
  • Red Bud, IL
  • NPI 1619693926
  Medicare reassignment Care Compare group
• Deaconess Illinois Red Bud Regional Hospital Inc

  • Critical Access Hospital
  • Red Bud, IL
  • NPI 1407573132
  NPD
• Allan L Liefer MD

  • Surgery Physician
  • Chester, IL
  • NPI 1972775856
  NPD (past)
• Family Practice Associates, PC

  • Family Medicine Physician
  • Waterloo, IL
  • NPI 1861688541
  NPD (past)

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

• Deaconess Illinois Red Bud Regional Hospital Inc

  • Critical Access Hospital
  • Red Bud, IL
  • NPI 1407573132
  Care Compare affiliation

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1477856979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 SPRING STREET",
            "city": "RED BUD",
            "state": "IL",
            "postal_code": "62278",
            "telephone_number": "618-282-3831",
            "fax_number": "618-282-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 SPRING STREET",
            "city": "RED BUD",
            "state": "IL",
            "postal_code": "62278",
            "telephone_number": "618-282-3831",
            "fax_number": "618-282-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUNDERLICH",
        "first_name": "MARY",
        "middle_name": "O",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-06",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-000332",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085000332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle A Turner, APN
• Susan Renee Tuttle, APN
• John L Vinyard, PHD
• Denae Marie White
• Kristin Lynn Wolter, LCPC
• Donna Yeargin

• Physician Assistant in Red Bud, IL
• Providers in Red Bud, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.