Active NPI
Mary Ellen Mahoney, M.D.
- Surgery Physician
- Eureka, CA
National Provider Identifier
1750352621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G48569
- Practice address
- 636 Harris St Ste a
Eureka, CA 95503-4448 - Phone
- (707) 476-0690
- Fax
- (707) 476-0692
- NPI assigned
- Jan 30, 2006
- Last updated
- Feb 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G48569 | CA | Primary |
Addresses
Primary practice location
636 Harris St Ste a
Eureka, CA 95503-4448
Mailing address
PO Box 990208
Redding, CA 96099-0208
Phone (530) 212-0073
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G485690 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090603000116 | CA | Practitioner - General Practice | 6204986862 | Practice locations: Eureka, CA |
Care Compare profile
Medicare Care Compare- Specialty
- General Practice
- Education
- Stanford University School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
636 Harris St
Eureka, CA 95503-4448
Phone (707) 476-0690
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Mastectomy | 36 |
| Melanoma (skin cancer) excision | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G48569 | CA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stanford Hospital and Clinics | Past | Accepting new patients | |
| Humboldt Foot & Ankle PC | Past | Accepting new patients | |
| Mad River Community Anesthesia Medical Group | Past | Accepting new patients | |
| Sequoia Strength Physical Therapy, Inc. | Past | Accepting new patients |
Interoperability endpoints
- m.mahoney@2576167534596.direct.elationemr.com
Organizations & group practices 4
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.
-
dba Humboldt Foot and Ankle
- Foot & Ankle Surgery Podiatrist
- Eureka, CA
- NPI 1508422015
-
- Pain Medicine (Anesthesiology) Physician
- Arcata, CA
- NPI 1578599619
-
- Physical Therapy Clinic/Center
- Eureka, CA
- NPI 1801503164
-
dba SHC Reference Laboratory
- Clinical Medical Laboratory
- Palo Alto, CA
- NPI 1174698468
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Mad River Community Hospital
- General Acute Care Hospital
- Arcata, CA
- NPI 1518996040
-
dba Providence Humboldt Home Infusion
- Home Infusion Therapy Pharmacy
- Eureka, CA
- NPI 1568422319
Hospital
-
dba Providence St. Joseph Hospital
- General Acute Care Hospital
- Eureka, CA
- NPI 1609858950
-
dba Providence St. Joseph Hospital
- General Acute Care Hospital
- Eureka, CA
- NPI 1891900635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706832000000",
"number": "1750352621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 990208",
"city": "REDDING",
"state": "CA",
"postal_code": "960990208",
"telephone_number": "530-212-0073",
"fax_number": "844-440-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 HARRIS ST STE A",
"city": "EUREKA",
"state": "CA",
"postal_code": "955034448",
"telephone_number": "707-476-0690",
"fax_number": "707-476-0692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONEY",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-30",
"last_updated": "2024-02-02",
"certification_date": "2024-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G48569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G485690",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.