Mary Callis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

56810-020 Issued in WI

Practice address

W3275 Wolf River Road
Menominee Tribal Clinic
Keshena, WI 54135-0970

Phone

(715) 799-3361

Fax

(715) 799-3099

NPI assigned

Dec 1, 2008

Last updated

Sep 28, 2012By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

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 2

Specialty

Emergency Medicine

Education

University of Utah School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Belvidere Emergency Physicians, LLCGroup PAC ID 1254794415, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uw Health Hospital, Rockford, IL, CCN 140228

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Belvidere Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Belvidere, IL
  • NPI 1306543319
  Medicare reassignment Care Compare group NPD
• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Midwest Medical Center

  • Critical Access Hospital
  • Galena, IL
  • NPI 1952409765
  Medicare reassignment NPD
• Rockford Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Rockford, IL
  • NPI 1639876634
  Medicare reassignment NPD
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD
• Midwest Medical Center

  • Rural Health Clinic/Center
  • Elizabeth, IL
  • NPI 1295286045
  NPD
• Menominee Indian Tribe of Wisconsin

  dba Menominee Tribal Rescue Service

  • Ambulance
  • Keshena, WI
  • NPI 1508808643
  NPD (past)

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

• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732
  Care Compare affiliation

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

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1730334020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "address_2": "MENOMINEE TRIBAL CLINIC",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3275 WOLF RIVER ROAD",
            "address_2": "MENOMINEE TRIBAL CLINIC",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLIS",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-01",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "56810-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy A Bevernitz, P.T.
• Timothy Arthur Bird, SAC-IT
• Davey Jean Boyd, SAC-IT
• Jodi M Burnett, OTR
• Addie Mae Caldwell, LPC
• Michael L Carlson, D.D.S.
• Dawn Marie Chambers, RDH
• Matthew J Charging, D.D.S.
• Robert P Chelberg, O.D.
• County of Menominee (Menominee County Human Services)

• Family Medicine Physician in Keshena, WI
• Providers in Keshena, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.