Mary Jo Stine, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01029565A Issued in IN

Practice address

35 Bob Babbs Dr
Spencer, IN 47460-6828

Phone

(812) 665-1700

Fax

(844) 605-9160

NPI assigned

Oct 11, 2005

Last updated

Jan 24, 2023By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Indiana Health Centers, Inc.

  dba Indiana Health Centers South Bend at Oaklawn

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
  • NPI 1598776742

  Pediatrics

  Medicare reassignment NPD
• Indiana Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
  • NPI 1942303086
  NPD
• Indiana Health Centers, Inc

  dba IHC-Owen County

  • Federally Qualified Health Center (FQHC)
  • Spencer, IN
  • NPI 1609315829
  NPD (past)
• Indiana Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Marion, IN
  • NPI 1619087624

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1619965803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "844-397-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 BOB BABBS DR",
            "city": "SPENCER",
            "state": "IN",
            "postal_code": "474606828",
            "telephone_number": "812-665-1700",
            "fax_number": "844-605-9160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Shelby St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462031151",
            "country_code": "US",
            "telephone_number": "317-488-2040",
            "fax_number": "317-488-2051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STINE",
        "first_name": "MARY",
        "middle_name": "JO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01029565A",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01029565A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100330490",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haylie Elizabeth Romer, LSW, MSW
• Christi Ryan, LCSW
• Stephanie Beth Sare
• Kimberly Shay
• Spencer Owen Community Schools
• Transitional Services Sub, LLC
• Transitional Services, Inc
• Valley Optical, Inc.
• Sheila R Vanhook, BSN, RN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-0996)

• Pediatrics Physician in Spencer, IN
• Providers in Spencer, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.