Mary Lela Valentine Vonder Haar, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00685 Issued in MS

Practice address

2222 Jackson Ave W
Oxford, MS 38655-5409

Phone

(662) 380-5560

NPI assigned

Sep 27, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Lela Valentine I Former name

Medicare fee-for-service enrollment

Enrolled in MS

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Women's Health, PLLCGroup PAC ID 2567497985, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.lela.vonder.haar.1@28954.direct.athenahealth.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.

• Southern Women's Health, PLLC

  • Obstetrics Physician
  • Jackson, MS
  • NPI 1174744379
  Medicare reassignment Care Compare group NPD
• Webb Family Medical Clinic PLLC

  • Family Medicine Physician
  • Water Valley, MS
  • NPI 1588201495
  Medicare reassignment
• Oxford Clinic for Women, PLLC

  • Specialist
  • Oxford, MS
  • NPI 1578105540
  NPD
• Southern Women's Health, PLLC

  dba Women's Pavilion of South Mississippi

  • Obstetrics & Gynecology Physician
  • Ellisville, MS
  • NPI 1407235971
  NPD

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1851800353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 JACKSON AVE W",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555409",
            "telephone_number": "662-380-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 JACKSON AVE W",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555409",
            "telephone_number": "662-380-5560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 N MacArthur Blvd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "75062",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 Westpark Way",
            "address_purpose": "LOCATION",
            "city": "Euless",
            "state": "TX",
            "postal_code": "760403902",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7429 Las Colinas Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750637573",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3501 N MacArthur Blvd Ste 360",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750623621",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3501 N MacArthur Blvd Ste 600",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750623651",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "313 Westpark Way",
            "address_purpose": "LOCATION",
            "city": "Euless",
            "state": "TX",
            "postal_code": "760403902",
            "country_code": "US",
            "telephone_number": "972-256-3700",
            "fax_number": "866-630-6348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VONDER HAAR",
        "first_name": "MARY LELA",
        "middle_name": "VALENTINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12044",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "VALENTINE",
            "middle_name": "LELA",
            "suffix": "I",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Jean Vinson, FNP-C
• Michael C. Vinson, PHARMD, MS
• Virtual Care Network LLC
• Sirpi Vivekanandam Sachithanandam, MBBS
• Amy Carole Vlach, PH.D
• Virginia Allyn Wachter, APRN
• Charles Robert Wade, D.C.
• Jennifer Edington Wade, APRN, BC
• Kimberly D Wadley, M.S.
• Staci Alys Waites, M.ED.

• Physician Assistant in Oxford, MS
• Providers in Oxford, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.