Active NPI
Mary Ann Gibbs, DC
- Chiropractor
- Seaside, OR
National Provider Identifier
1649301052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 272517
- Practice address
- 45 N Holladay Dr
Seaside, OR 97138 - Phone
- (503) 738-7343
- Fax
- (503) 738-9946
- NPI assigned
- Mar 8, 2007
- Last updated
- Nov 3, 2011
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 272517 | OR | Primary |
Addresses
Primary practice location
45 N Holladay Dr
Seaside, OR 97138
Mailing address
45 N Holladay Dr
Seaside, OR 97138
Phone (503) 738-7343
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076711 | Medicaid | OR | |
| 862925002 | Other | OR | REGENCE BLUE CROSS |
Other names 1
- Mary Ann Boland
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1987
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
45 N Holladay Dr
Seaside, OR 97138-6839
Phone (503) 738-7343
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 272517 | OR | MD | Chiropractor |
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.
-
- Chiropractor
- Seaside, OR
- NPI 1679605828
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1649301052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 N HOLLADAY DR",
"city": "SEASIDE",
"state": "OR",
"postal_code": "97138",
"telephone_number": "503-738-7343",
"fax_number": "503-738-9946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 N HOLLADAY DR",
"city": "SEASIDE",
"state": "OR",
"postal_code": "97138",
"telephone_number": "503-738-7343",
"fax_number": "503-738-9946"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBS",
"first_name": "MARY",
"middle_name": "ANN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "272517",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "076711",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE CROSS",
"identifier": "862925002",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "BOLAND",
"middle_name": "ANN",
"credential": "DC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Seaside, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.