Individual provider Active NPI

Mary E. Mahony, D.O.

  • Pediatrics Physician
  • Rogers, MN
National Provider Identifier
1760459259
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
47041 Issued in MN
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

Updated by the provider on Sep 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
487479000MedicaidMN

Other names 1

  • Dr. Marybeth Mahony Other name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041027000912 MN Practitioner - Pediatric Medicine 7214999705 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
47041MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Clinic Network CurrentSince Jan 1, 2015 Accepting new patients
Children'S Clinic Network Current Accepting new patients
Children'S Clinic Network CurrentSince Jan 1, 2015 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.