NPIMap

Individual provider Active NPI

Mary V Mirto, D.O.

  • Obstetrics & Gynecology Physician
  • Austin, TX
National Provider Identifier
1861403917
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
L1674 Issued in TX
Practice address
2608 Brockton Dr
Austin, TX 78758-4414
Phone
(512) 654-4050
Fax
(512) 654-4051
NPI assigned
Aug 11, 2006
Last updated
Jan 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X L1674 TX Primary

Addresses

Primary practice location

2608 Brockton Dr
Austin, TX 78758-4414

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other identifiers 1

IdentifierTypeStateIssuer
153610401MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmirto447951@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150205001406 TX Practitioner - Obstetrics/Gynecology 8820313208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

2600 E Pflugerville Pkwy
BLDG 2
Pflugerville, TX 78660-5998
Phone (512) 654-6500

5701 Airport Rd
Temple, TX 76502-7092

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L1674TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Obstetrics & Gynecology Current Accepting new patients
Scott & White Clinic Obstetrics & Gynecology CurrentSince Feb 5, 2019 Accepting new patients
Scott and White Clinic Obstetrics & Gynecology CurrentSince Feb 5, 2019 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

2608 Brockton Dr
Austin, TX 78758
Phone (512) 654-4050

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

2600 E Pflugerville Pkwy
Bldg 2
Pflugerville, TX 78660
Phone (512) 564-6500

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: mmirto447951@direct.sw.org

Organizations & group practices 4

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1861403917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 BROCKTON DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787584414",
            "telephone_number": "512-654-4050",
            "fax_number": "512-654-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRTO",
        "first_name": "MARY",
        "middle_name": "V",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L1674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153610401",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmirto447951@direct.sw.org",
            "affiliation": "N",
            "address_1": "2608 Brockton Dr",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787584414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.