Mary Sue Illions Berry, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A7048 Issued in CA

Practice address

500 S Anaheim Hills Rd
Suite 242
Anaheim Hills, CA 92807-4780

Phone

(714) 974-0611

Fax

(714) 221-2299

NPI assigned

Dec 29, 2005

Last updated

Sep 26, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Anaheim Hills Wellness Center, a Medical Corporation

  • Family Medicine Physician
  • Anaheim Hills, CA
  • NPI 1750368874
  NPD (past) Authorized official

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1568449783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S ANAHEIM HILLS RD",
            "address_2": "SUITE 242",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "928074780",
            "telephone_number": "714-974-0611",
            "fax_number": "714-221-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S ANAHEIM HILLS RD",
            "address_2": "SUITE 242",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "928074780",
            "telephone_number": "714-974-0611",
            "fax_number": "714-221-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "MARY",
        "middle_name": "SUE ILLIONS",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A7048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LIC",
            "identifier": "20A7048",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anaheim Hills Wellness Center, a Medical Corporation
• Ando & Aston Physical Therapy, Inc.
• Beavans Medical, Inc.
• Marc Becker, PH.D.
• Michael Max Belda, DDS
• Terisa Marie Brown-Sienko, NP
• Harry Joel Charm, OD
• Caren Hui-Min Chen, MD
• Children's Medical Group of Orange County Apc (children's medical group of orange county)
• Bernadine M Deramo, NP

• Family Medicine Physician in Anaheim Hills, CA
• Providers in Anaheim Hills, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.