NPIMap

Individual provider Active NPI

Mary Margaret McCoy, P.A

  • Physician Assistant
  • Shawano, WI
National Provider Identifier
1518264761
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3014 Issued in WI
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(715) 823-5161
NPI assigned
Feb 24, 2011
Last updated
Oct 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014485 NY
Physician Assistant 363A00000X 3014 WI Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (715) 823-5161

Other practice location 1

1825 Eastchester Rd
Bronx, NY 10461-2301
Phone (718) 904-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20121008000117 WI Practitioner - Physician Assistant 1456536481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (715) 526-2111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3014WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jun 14, 2015 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jun 14, 2015 Accepting new patients
Montefiore Medical Center Past Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: mmccoy163611@direct.thedacare.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1518264761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "715-823-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-823-5161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 Eastchester Rd",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104612301",
            "country_code": "US",
            "telephone_number": "718-904-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "MARY",
        "middle_name": "MARGARET",
        "credential": "P.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014485",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawano, WI

Sources for this page

Verify at the official NPI Registry.