Active NPI
Mary E Pagano, MD
- Internal Medicine Physician
- Racine, WI
National Provider Identifier
1639286958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 30032
- Practice address
- 5333 Douglas Ave
Racine, WI 53402 - Phone
- (262) 752-2100
- Fax
- (262) 752-2122
- NPI assigned
- Aug 23, 2006
- Last updated
- Mar 7, 2023
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 30032 | WI | Primary |
Addresses
Primary practice location
5333 Douglas Ave
Racine, WI 53402
Mailing address
3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (414) 647-6326
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31470100 | Medicaid | WI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30032 | WI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1639286958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 W FOREST HOME AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532152843",
"telephone_number": "414-647-6326",
"fax_number": "414-671-8860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5333 DOUGLAS AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "53402",
"telephone_number": "262-752-2100",
"fax_number": "262-752-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAGANO",
"first_name": "MARY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "30032",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31470100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.