Mary Jo Eline, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

OS005976L Issued in PA

Practice address

35 Monument Rd
Suite 201
York, PA 17403-5074

Phone

(717) 812-4083

Fax

(717) 812-2244

NPI assigned

Dec 21, 2005

Last updated

Jun 30, 2016By 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 9

Other names 1

• Mary Jo Theresa Wysock Former name

Medicare fee-for-service enrollment

Enrolled in NC

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

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.

• Yadkin River Radiology PA

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1710908041
  Medicare reassignment NPD
• Chatham Radiologists, PA

  • Diagnostic Radiology Physician
  • Savannah, GA
  • NPI 1285663443
  NPD (past)
• Coastal Plains Physician Associates

  • Diagnostic Radiology Physician
  • Varnville, SC
  • NPI 1316992506
  NPD (past)
• Doshi Diagnostic Imaging Services PC

  • Diagnostic Radiology Physician
  • Hicksville, NY
  • NPI 1720031339
  NPD (past)
• Gwinnett Clinic LTD

  dba Gwinnett Clinic

  • Multi-Specialty Clinic/Center
  • Duluth, GA
  • NPI 1629117650
  NPD (past)
• KC Tan, M.D. Medical Corporation

  • Neuroradiology Physician
  • Monterey Park, CA
  • NPI 1215394036

  Diagnostic Radiology

  NPD (past)
• Radiology Group LLC

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1003866583
  NPD (past)
• The Baxley and Appling County Hospital Authority

  dba Appling Medical Group

  • Rural Health Clinic/Center
  • Baxley, GA
  • NPI 1073752143
  NPD (past)
• The Baxley and Appling County Hospital Authority

  dba Appling Medical Group

  • General Practice Physician
  • Baxley, GA
  • NPI 1518967116
  NPD (past)

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1659357655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-812-4083",
            "fax_number": "717-812-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MONUMENT RD",
            "address_2": "SUITE 201",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174035074",
            "telephone_number": "717-812-4083",
            "fax_number": "717-812-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELINE",
        "first_name": "MARY JO",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "043603",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "OS005976L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000869514C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC-WMG",
            "identifier": "751227",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "2502433",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH MERCY-WMG",
            "identifier": "30075311",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035832100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY-WMG",
            "identifier": "1588746",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "919374",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON-WMG",
            "identifier": "301200",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102451961",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY JO",
            "last_name": "WYSOCK",
            "middle_name": "THERESA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Essam El Maghrabi, MD
• Dominique El-Khawand, M.D.
• Allison Megan Eliason, CRNP
• Eline Dental PLLC (West Side Dental)
• Christopher Austin Eline, D.D.S.
• Lisa Caroline Eller, CRNA
• Mary Elaine Elliott, R.PH.
• River McKenzie Elliott, M.D.
• Abigail P Ellis, PA-C
• Craig W. Ellis, D.P.M.

• Diagnostic Radiology Physician in York, PA
• Providers in York, PA by specialty
• Diagnostic Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.
• 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.

Verify at the official NPI Registry.