Active NPI
Mary E Bystrom
- Surgery Physician
- Denver, CO
National Provider Identifier
1598892564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 73614
- Practice address
- 1375 E 20TH Ave
Denver, CO 80205-5423 - Phone
- (303) 764-4463
- NPI assigned
- Feb 27, 2007
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 73614 | CO | Primary |
Addresses
Primary practice location
1375 E 20TH Ave
Denver, CO 80205-5423
Mailing address
5895 E Weaver Cir
Centennial, CO 80111-4331
Phone (303) 740-8178
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012531 | Other | KAISER-COMMERCIAL NUMBER |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73614 | CO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598892564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5895 E WEAVER CIR",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "801114331",
"telephone_number": "303-740-8178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 E 20TH AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802055423",
"telephone_number": "303-764-4463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYSTROM",
"first_name": "MARY",
"middle_name": "E",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "73614",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER-COMMERCIAL NUMBER",
"identifier": "012531",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.