Active NPI
Mary E. Mahony, D.O.
- Pediatrics Physician
- Rogers, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 47041
- Practice address
- 13980 Northdale Blvd
Rogers, MN 55374-2147 - Phone
- (763) 428-1920
- Fax
- (763) 428-3162
- NPI assigned
- Mar 2, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 47041 | MN | Primary |
Addresses
Primary practice location
13980 Northdale Blvd
Rogers, MN 55374-2147
Mailing address
13980 Northdale Blvd
Rogers, MN 55374-2147
Phone (763) 428-1920
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 487479000 | Medicaid | MN |
Other names 1
- Dr. Marybeth Mahony
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47041 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Clinic Network | Current | Accepting new patients | |
| Children'S Clinic Network | Current | Accepting new patients | |
| Children'S Clinic Network | Current | Accepting new patients | |
| Maple Grove Hospital Corporation | Past | Accepting new patients | |
| Partners in Pediatrics, LTD. | Pediatrics | Past | Accepting new patients |
| Metropolitan Pediatric Specialists, P.a. | Past | Accepting new patients |
Locations
12720 Bass Lake Rd
Maple Grove, MN 55369
Phone (763) 278-0804
5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691
3910 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 562-8787
1547 Livingston Ave
West St Paul, MN 55118
Phone (651) 451-8050
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Hugo, MN
- NPI 1447529235
-
- Primary Care Clinic/Center
- West St Paul, MN
- NPI 1346513447
-
- Primary Care Clinic/Center
- Brooklyn Park, MN
- NPI 1588522668
-
- General Acute Care Hospital
- Maple Grove, MN
- NPI 1225272552
-
- Clinic/Center
- Edina, MN
- NPI 1558459206
-
- Pediatrics Physician
- Maple Grove, MN
- NPI 1487604104
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1760459259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13980 NORTHDALE BLVD",
"city": "ROGERS",
"state": "MN",
"postal_code": "553742147",
"telephone_number": "763-428-1920",
"fax_number": "763-428-3162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13980 NORTHDALE BLVD",
"city": "ROGERS",
"state": "MN",
"postal_code": "553742147",
"telephone_number": "763-428-1920",
"fax_number": "763-428-3162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONY",
"first_name": "MARY",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-02",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "47041",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "487479000",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARYBETH",
"last_name": "MAHONY",
"prefix": "DR.",
"credential": "D.O.",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Rogers, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.