Individual provider Active NPI

Mary E Bruce, PA

  • Surgical Physician Assistant
  • Akron, OH
National Provider Identifier
1508974700
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50.006760RX Issued in OH
Practice address
1 Perkins SQ
Akron, OH 44308-1063
Phone
(330) 543-8224
Fax
(330) 543-3648
NPI assigned
Aug 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA2344 TN
Surgical Physician Assistant 363AS0400X 009354-1 NY
Surgical Physician Assistant 363AS0400X 50.006760RX OH Primary

Addresses

Primary practice location

1 Perkins SQ
Akron, OH 44308-1063

Mailing address

1 Perkins SQ
Akron, OH 44308-1063
Phone (330) 543-8224

Other identifiers 3

IdentifierTypeStateIssuer
199763795MedicaidAR
07950511MedicaidMS
Q002143MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbruce108500@direct.chmca.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20210310003008 OH Practitioner - Physician Assistant 7315944113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Perkins SQ
Akron, OH 44308-1063
Phone (330) 543-1000

One Perkins Square
Akron, OH 44308-1063
Phone (330) 543-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2344TNMDChiropractor
009354-1NYMDSurgical Physician Assistant
50.006760RXOHMDSurgical Physician Assistant
PA2344TNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph'S Pathology, PC Current Accepting new patients
Children'S Hospital Medical Center of Akron CurrentSince Jan 31, 2021 Accepting new patients
Children'S Hospital Medical Center of Akron Current Accepting new patients
Children'S Hospital Medical Center of Akron CurrentSince Jan 31, 2021 Accepting new patients
Akron Children'S Hospital Current Accepting new patients

Locations

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

1 Perkins Sq
Akron, OH 44308
Phone (330) 543-8050

Organizations & group practices 5

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.

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1508974700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-543-8224",
            "fax_number": "330-543-3648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-543-8224",
            "fax_number": "330-543-3648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "PA2344",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "009354-1",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50.006760RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199763795",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07950511",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q002143",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbruce108500@direct.chmca.org",
            "affiliation": "N",
            "address_1": "1 Perkins Sq",
            "city": "Akron",
            "state": "OH",
            "country_code": "US",
            "postal_code": "443081063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

Verify at the official NPI Registry.