Mary Edem, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

20107 Issued in CA

Practice address

190 E Highland Ave
San Bernardino, CA 92404-3658

Phone

(909) 882-4788

Fax

(877) 860-7268

NPI assigned

Jan 18, 2011

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Inland Psychiatric Medical Group IncGroup PAC ID 9436062312, 119 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: lifestancehealth.maryedem@148377.advancedmd-direct.com

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.

• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1649217761

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Ehab Yacoub MD Inc.

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment NPD
• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1336977990

  Psychiatric/Mental Health

  NPD
• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Moreno Valley, CA
  • NPI 1427104116

  Nurse Practitioner

  NPD
• Neighborhood Medical Clinic of Riverside

  • Psychiatry Physician
  • Riverside, CA
  • NPI 1073663605
  NPD (past)
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• Redlands Community Hospital

  • General Acute Care Hospital
  • Redlands, CA
  • NPI 1043354111
  NPD (past)

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1760787030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE",
            "address_2": "SUITE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E HIGHLAND AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043658",
            "telephone_number": "909-882-4788",
            "fax_number": "877-860-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDEM",
        "first_name": "MARY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-18",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "20107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastfield Ming Quong
• Easy Living Home Healthcare Supplies
• Sara Eberly, M.S.
• Ebtks Medical Center, a Prof Corp.
• Dale L Ecker-Gordon, BA RBT
• Deshawn Jahmal Edge-Hughes
• Andrew Edmunds
• Educuras Registered Nursing P.C.
• Edward G. Stokes, MD, Inc.
• Edward J Puttre Jr MD Inc

• Psychiatric/Mental Health Nurse Practitioner in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.