Individual provider Active NPI

Mary Menz

  • Maternal Newborn Registered Nurse
  • Sikeston, MO
National Provider Identifier
1760115257
Registry record updated Jul 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal Newborn Registered NurseTaxonomy code 163WM0102X
License
2018021926 Issued in MO
Practice address
180 Rainbow Lake Rd
Sikeston, MO 63801-8752
Phone
(573) 258-2886
NPI assigned
Jul 3, 2022
Last updated
Jul 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal Newborn Registered Nurse 163WM0102X 2018021926 MO Primary

Addresses

Primary practice location

180 Rainbow Lake Rd
Sikeston, MO 63801-8752

Mailing address

180 Rainbow Lake Rd
Sikeston, MO 63801-8752

Other identifiers 1

IdentifierTypeStateIssuer
66383640MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address emenz@missouridelta.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250415001548 MO Practitioner - Nurse Practitioner 6507381365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Missouri Delta Medical CenterGroup PAC ID 1355252891, 134 clinicians

Practice addresses (Care Compare)

1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 471-1600

1015 N Main St
Sikeston, MO 63801-5043
Phone (573) 472-7777

1017 N Main St
Sikeston, MO 63801-5043
Phone (573) 472-6030

1019 N Main St
Sikeston, MO 63801-5043
Phone (573) 472-7702

1106 N Main St
Missouri Delta Urology
Sikeston, MO 63801-5046
Phone (573) 471-8656

1118 N Main St
Sikeston, MO 63801-5046
Phone (573) 471-4417

1126 N Main St
Sikeston, MO 63801-5046
Phone (573) 471-4312

125 Plaza Dr
Sikeston, MO 63801-5136
Phone (573) 472-7124

135 Plaza Dr
Sikeston, MO 63801-5148

201 Plaza Dr
Sikeston, MO 63801-5110

201 Plaza Dr
Suite C
Sikeston, MO 63801-5105
Phone (573) 481-1072

203 Plaza Dr
Sikeston, MO 63801-5105
Phone (573) 475-6488

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2018021926MOMDMaternal Newborn Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Delta Medical Center CurrentSince Mar 24, 2025 Accepting new patients
Missouri Delta Medical Center CurrentSince Mar 24, 2025 Accepting new patients

Locations

1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1656806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656806400000",
    "number": "1760115257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 RAINBOW LAKE RD",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638018752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 RAINBOW LAKE RD",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638018752",
            "telephone_number": "573-258-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENZ",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-03",
        "last_updated": "2022-07-03",
        "certification_date": "2022-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "MO",
            "license": "2018021926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66383640",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emenz@missouridelta.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "address_1": "180 Rainbow Lake Rd",
            "city": "Sikeston",
            "state": "MO",
            "country_code": "US",
            "postal_code": "638018752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

Verify at the official NPI Registry.