NPIMap

Individual provider Active NPI

Mary Portera

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1861072514
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR0072962 Issued in CO
Practice address
630 W 168TH St PH 8
New York, NY 10032-3725
Phone
(212) 305-5960
NPI assigned
Apr 8, 2021
Last updated
Jun 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR0072962 CO Primary

Addresses

Primary practice location

630 W 168TH St PH 8
New York, NY 10032-3725

Mailing address

8697 Classic Cir
Memphis, TN 38125-8829
Phone (901) 305-4022

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL http://columbiamedicine.org/about/contact.shtml Direct
Other URL http://columbiamedicine.org/about/contact.shtml Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20240802001694 CO Practitioner - Internal MedicinePractitioner - Hospitalist 0840737235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
University of Tennessee, HSC, College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0072962COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Colorado LLC Current Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2024 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2024 Accepting new patients
North Colorado Medical Center Past Accepting new patients
North Colorado Medical Center Past Accepting new patients

Locations

4700 Lady Moon Dr
Fort Collins, CO 80528
Phone (970) 521-4600

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1861072514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8697 CLASSIC CIR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381258829",
            "telephone_number": "901-305-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST PH 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-305-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTERA",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-08",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR0072962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://columbiamedicine.org/about/contact.shtml",
            "affiliation": "N",
            "endpointDescription": "Residency Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "630 W 168th St Ph 8",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://columbiamedicine.org/about/contact.shtml",
            "affiliation": "N",
            "endpointDescription": "Residency Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "630 W 168th St Ph 8",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.