Individual provider Active NPI

Mary Ann Burke, RPT

  • Physical Medicine & Rehabilitation Physician
  • Paso Robles, CA
National Provider Identifier
1710045422
Registry record updated Sep 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
PT16770 Issued in CA
Practice address
1191 Creston Rd. #115
Paso Robles, CA 93446-3033
Phone
(805) 227-4156
Fax
(805) 227-4899
NPI assigned
Dec 5, 2006
Last updated
Sep 4, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X PT16770 CA Primary

Addresses

Primary practice location

1191 Creston Rd. #115
Paso Robles, CA 93446-3033

Mailing address

1191 Creston Rd. #115
Paso Robles, CA 93446-3033
Phone (805) 227-4156

Other identifiers 4

IdentifierTypeStateIssuer
GPT001411MedicaidCA
OPT16770OtherCABLUE SHIELD
PT16770OtherCATRICARE
PT16770OtherCABLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051214000915 CA Practitioner - Physical Therapist in Private Practice 9931120250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6713 Morro Rd
Atascadero, CA 93422-4137
Phone (805) 461-5514

Merit-based Incentive Payment System (MIPS)

Final score
90.16 of 100Reported as individual
Quality
82.1
Improvement activities
40
Cost
88.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16770CAMDDental Hygienist
PT16770CAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North County Physical Therapy, Inc CurrentSince Aug 1, 2005 Accepting new patients
North County Physical Therapy,Inc. CurrentSince Aug 1, 2005 Accepting new patients

Locations

6713 Morro Rd
Atascadero, CA 93422
Phone (805) 461-5514

1191 Creston Rd
Ste 115
Paso Robles, CA 93446
Phone (805) 239-3696

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1710045422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 CRESTON RD. #115",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934463033",
            "telephone_number": "805-227-4156",
            "fax_number": "805-227-4899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 CRESTON RD. #115",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934463033",
            "telephone_number": "805-227-4156",
            "fax_number": "805-227-4899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "MARY ANN",
        "name_prefix": "Mrs.",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "PT16770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT001411",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "OPT16770",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "PT16770",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PT16770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paso Robles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; 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.

Verify at the official NPI Registry.