Active NPI
Mary Rosenhauer, PA-C
- Medical Physician Assistant
- Carbondale, IL
National Provider Identifier
1679511281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 085-001667
- Practice address
- 1350 Cedar CT
Carbondale, IL 62901-5336 - Phone
- (618) 529-2955
- NPI assigned
- Jun 4, 2006
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085-001667 | IL | Primary |
Addresses
Primary practice location
1350 Cedar CT
Carbondale, IL 62901-5336
Mailing address
1350 Cedar CT
Carbondale, IL 62901-5336
Phone (618) 529-2955
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085-001667 | Other | IL | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-001667 | IL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224720000000",
"number": "1679511281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 CEDAR CT",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629015336",
"telephone_number": "618-529-2955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 CEDAR CT",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629015336",
"telephone_number": "618-529-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENHAUER",
"first_name": "MARY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-04",
"last_updated": "2008-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IL",
"license": "085-001667",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "085-001667",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.