Individual provider Active NPI

Mary Wilber, D.O.

  • Psychiatry Physician
  • Medford, MA
National Provider Identifier
1649407388
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
241761 Issued in MA
Practice address
170 Governors Avenue
Medford, MA 02155
Phone
(617) 665-1185
NPI assigned
Jun 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 241761 MA Primary

Addresses

Primary practice location

170 Governors Avenue
Medford, MA 02155

Mailing address

170 Governors Avenue
Medford, MA 02155
Phone (617) 665-1185

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20150228000041 MA Practitioner - Geriatric Psychiatry 1557687001 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Psychiatry
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.27 of 100Reported as group
Quality
77.51
Promoting interoperability
100
Improvement activities
40
Cost
76.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Melrosewakefield Healthcare, Inc. Current Accepting new patients
Melrosewakefield Healthcare, Inc. CurrentSince Jan 15, 2021 Accepting new patients
Cambridge Public Health Commission CurrentSince Jul 1, 2014 Accepting new patients
Cambridge Public Health Commission CurrentSince Jul 1, 2014 Accepting new patients
Hallmark Health System Inc Psychiatry CurrentSince Jan 15, 2021 Accepting new patients
Cambridge Public Health Commission Past Accepting new patients

Locations

1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

350 Main St
Ste 31
Malden, MA 02148
Phone (781) 397-6583

170 Governors Ave
Medford, MA 02155
Phone (781) 306-6000

Interoperability endpoints

  • Direct secure messaging: mwilber37379@direct.challiance.masshiway.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1245542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1649407388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVENUE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "02155",
            "telephone_number": "617-665-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVENUE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "02155",
            "telephone_number": "617-665-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBER",
        "first_name": "MARY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-21",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "241761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.