Active NPI
Mary C White, DPM
- Podiatrist
- Rockford, IL
National Provider Identifier
1649293952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 016004011
- Practice address
- 6451 E Riverside Blvd
Ste 104
Rockford, IL 61114-4421 - Phone
- (815) 282-4000
- NPI assigned
- Jul 26, 2006
- Last updated
- Nov 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 016004011 | IL | Primary |
Addresses
Primary practice location
6451 E Riverside Blvd
Ste 104
Rockford, IL 61114-4421
Mailing address
6451 E Riverside Blvd
Ste 104
Rockford, IL 61114-4421
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4760030001 | Other | IL | DMERC |
| P00050197 | Other | IL | RAILROAD MEDICARE |
| 60101278 | Other | IL | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016004011 | IL | MD | Podiatrist |
Organizations & group practices 1
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.
-
- Podiatrist
- Rockford, IL
- NPI 1174724520
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1649293952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6451 E RIVERSIDE BLVD",
"address_2": "STE 104",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611144421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6451 E RIVERSIDE BLVD",
"address_2": "STE 104",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611144421",
"telephone_number": "815-282-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "MARY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2022-11-29",
"certification_date": "2022-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IL",
"license": "016004011",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "4760030001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00050197",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "60101278",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.