Mary Therese Fornetti, MMS PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2012005497 Issued in MO

Practice address

325 E H St
Iron Mountain, MI 49801-4760

Phone

(906) 774-3300

NPI assigned

Dec 3, 2011

Last updated

Jun 17, 2013By 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

Other names 1

• Mary Therese Gloss Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aspirus Ironwood Hospital and Clinics IncGroup PAC ID 9032013198, shared by 5 NPIs, 165 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

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.

• North County Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Florissant, MO
  • NPI 1356366934

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1322870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371427200000",
    "number": "1760750889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNETTI",
        "first_name": "MARY",
        "middle_name": "THERESE",
        "name_prefix": "Mrs.",
        "credential": "MMS PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-03",
        "last_updated": "2013-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2012005497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "GLOSS",
            "middle_name": "THERESE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Thomas Floyd III, PH.D.
• Focus on Function Physical Therapy, P.C.
• Anthony Joseph Fornetti, DDS
• Daniel John Fornetti, DDS
• John Thomas Fornetti, DDS
• Paul J Fornetti, D.D.S.
• Theodore A Fornetti, DDS
• Kristen Scott Forstrom, APNP, NP-C
• Paige Alyn Fortner, AGACNP-BC
• Nicole Marie Foster Holdwick, LMSW

• Physician Assistant in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; 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.