Individual provider Active NPI

Mary Joyce Campos Woody, AU.D.

  • Audiologist
  • Bend, OR
National Provider Identifier
1558628669
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
30949 Issued in OR
Practice address
2205 NW Shevlin Park Rd
Bend, OR 97703-7195
Phone
(541) 678-5698
NPI assigned
Apr 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 30949 OR Primary

Addresses

Primary practice location

2205 NW Shevlin Park Rd
Bend, OR 97703-7195

Mailing address

2205 NW Shevlin Park Rd
Bend, OR 97703-7195
Phone (541) 678-5698

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191118000796 OR Practitioner - Qualified Audiologist 6608019989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Zimmerman Group, LLCGroup PAC ID 1153713466, 3 clinicians

Practice addresses (Care Compare)

2205 NW Shevlin Park Rd
Bend, OR 97703-7195
Phone (541) 678-5698

2450 NE Mary Rose PL
Suite 120
Bend, OR 97701-7132
Phone (541) 382-3100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30949ORMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Jones Hearing AIDS, Inc. CurrentSince Jul 27, 2013 Accepting new patients
Zimmerman Group, LLC Audiologist CurrentSince Dec 1, 2021 Accepting new patients
Central Oregon ENT LLC - Ear Nose Throat and Facial Plastic Surgey CurrentSince Oct 1, 2025 Accepting new patients

Locations

1431 Southwest Blvd
Ste 1
Jefferson City, MO 65109
Phone (573) 635-3557

2205 NW Shevlin Park Rd
Bend, OR 97703
Phone (541) 678-5698

2055 NW Shevlin Park Rd
Bend, OR 97703

2450 NE Mary Rose Pl
Ste 120
Bend, OR 97701
Phone (541) 382-3100

2855 NW Crossing Dr
Ste 101
Bend, OR 97703
Phone (541) 330-6003

1734 Lark St
Klamath Falls, OR 97601
Phone (541) 382-3100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1558628669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 NW SHEVLIN PARK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037195",
            "telephone_number": "541-678-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 NW SHEVLIN PARK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037195",
            "telephone_number": "541-678-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODY",
        "first_name": "MARY JOYCE",
        "middle_name": "CAMPOS",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-13",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "30949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.