Mary Louise Bodewes, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2021-0130 Issued in NM

Practice address

630 W Maple St
Farmington, NM 87401-6113

Phone

(505) 609-6349

NPI assigned

Sep 14, 2006

Last updated

Nov 8, 2024By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO, NM2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Juan Regional Medical Center, Inc.Group PAC ID 4587559505, 233 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Juan Regional Medical Center Inc Hospital, Farmington, NM, CCN 320005

Merit-based Incentive Payment System (MIPS)

Final score

90.97 of 100Reported as group

Quality

79.73

Promoting interoperability

100

Improvement activities

40

Cost

78.87

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• San Juan Regional Medical Center Inc

  dba SJHP Gastroenterology

  • Gastroenterology Physician
  • Farmington, NM
  • NPI 1639662901
  Medicare reassignment Care Compare group NPD
• San Juan Regional Medical Center Inc

  dba San Juan Regional Cardiology

  • Cardiovascular Disease Physician
  • Farmington, NM
  • NPI 1033327770

  CO

  Medicare reassignment
• San Juan Regional Medical Center Inc

  dba SJHP Family Medicine Farmington

  • Family Medicine Physician
  • Farmington, NM
  • NPI 1710589015
  NPD
• San Juan Regional Medical Center Inc

  dba San Juan Health Partners Family and Specialty Medicine

  • Cardiovascular Disease Physician
  • Durango, CO
  • NPI 1902463508
  NPD

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

• San Juan Regional Medical Center Inc

  dba SJRMC Inpatient Rehab Unit

  • Rehabilitation Hospital Unit
  • Farmington, NM
  • NPI 1326663592
  Care Compare affiliation
• San Juan Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Farmington, NM
  • NPI 1427058510
  Care Compare affiliation

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1659476398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844088",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844088",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W MAPLE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016113",
            "telephone_number": "505-609-6349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1485 Florida Rd Ste 103A",
            "address_purpose": "LOCATION",
            "city": "Durango",
            "state": "CO",
            "postal_code": "813016873",
            "country_code": "US",
            "telephone_number": "970-444-0260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2727 Plaza Drive",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "54401",
            "country_code": "US",
            "telephone_number": "715-358-1184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODEWES",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "988",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.005343",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2021-0130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42971200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Bliss, MD
• Jeff Blomstedt, DDS
• Bloom New Mexico LLC (American Family Care)
• Samaira Bluehouse
• Bobby G Painter OD (High Desert Eye Care)
• Carrie Boehm, RDH
• Peter Boehringer, M.D.
• Bonham & Associates
• Bonham and Associates
• Richard David Bonham, LADAC

• Physician Assistant in Farmington, NM
• Providers in Farmington, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; 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.