Active NPI
Mary C Haller, MD
- Rheumatology Physician
- Hancock, MI
National Provider Identifier
1487607230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- MI43048076
- Practice address
- 500 Campus Dr
Hancock, MI 49930-1569 - Phone
- (906) 483-1730
- Fax
- (906) 483-1380
- NPI assigned
- May 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | MI43048076 | MI | Primary |
Addresses
Primary practice location
500 Campus Dr
Hancock, MI 49930-1569
Mailing address
500 Campus Dr
Hancock, MI 49930-1569
Phone (906) 483-1730
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102928716 | Medicaid | MI | |
| MH048076 | Other | MI | BLUECROSS STATE ID |
| 0829560001 | Other | MI | MEDICARE DME |
| 0C16002 | Other | MEDICARE GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MI43048076 | MI | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1487607230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CAMPUS DR",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301569",
"telephone_number": "906-483-1730",
"fax_number": "906-483-1380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CAMPUS DR",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301569",
"telephone_number": "906-483-1730",
"fax_number": "906-483-1380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLER",
"first_name": "MARY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MI",
"license": "MI43048076",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102928716",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS STATE ID",
"identifier": "MH048076",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE DME",
"identifier": "0829560001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "0C16002",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Hancock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.