NPIMap

Individual provider Active NPI

Mary Louise Kerber, MD

  • Neurology Physician
  • Cheyenne, WY
National Provider Identifier
1790768760
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
7050A Issued in WY
Practice address
5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone
(307) 634-1311
Fax
(307) 634-1271
NPI assigned
Nov 23, 2005
Last updated
Feb 24, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 7050A WY Primary

Addresses

Primary practice location

5050 Powderhouse Rd
Cheyenne, WY 82009-4800

Mailing address

2695 Rocky Mountain Ave
Suite 150
Loveland, CO 80538-8702
Phone (970) 624-4443

Other identifiers 1

IdentifierTypeStateIssuer
119766500MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040605000221 WY Practitioner - Neurology 9638075583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Texas Medical School at San Antonio, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30975AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince May 1, 2012 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients
Sun Health MRI Center Past Accepting new patients

Locations

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

5050 Powderhouse Rd
Cheyenne, WY 82009
Phone (307) 634-1311

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

Organizations & group practices 3

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1790768760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE",
            "address_2": "SUITE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388702",
            "telephone_number": "970-624-4443",
            "fax_number": "970-490-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 POWDERHOUSE RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094800",
            "telephone_number": "307-634-1311",
            "fax_number": "307-634-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERBER",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WY",
            "license": "7050A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119766500",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.