Individual provider Active NPI

Mary Katherine Bohr, M.S. CCC-A

  • Audiologist
  • Riverhead, NY
National Provider Identifier
1871688556
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
002094-1 Issued in NY
Practice address
818 E Main St
Riverhead, NY 11901-2563
Phone
(631) 369-2808
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 002094-1 NY Primary

Addresses

Primary practice location

818 E Main St
Riverhead, NY 11901-2563

Mailing address

35 Hampton CT
Coram, NY 11727-1628
Phone (631) 642-1953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071114000019 NY Practitioner - Qualified Audiologist 8325136021 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
51 Sandalwood Enterprises IncGroup PAC ID 1850205311, 3 clinicians

Practice addresses (Care Compare)

475 E Main St
Suite 112
Patchogue, NY 11772-3121
Phone (631) 758-3709

818 E Main St
Riverhead, NY 11901-2563
Phone (631) 369-2808

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002094NYMDArt Therapist
002094-1NYMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
51 Sandalwood Enterprises, Inc CurrentSince Sep 18, 2008 Accepting new patients
51 Sandalwood Enterprises Inc CurrentSince Sep 18, 2008 Accepting new patients
55 Sandalwood Enterprises Inc CurrentSince Aug 1, 2016 Accepting new patients
Northland Hearing Centers, Inc. Past Accepting new patients

Locations

23 S Howell Ave
Ste M
Centereach, NY 11720
Phone (631) 284-2299

475 E Main St
Patchogue, NY 11772
Phone (631) 363-2001

818 E Main St
Riverhead, NY 11901
Phone (631) 284-2299

325 Meeting House Ln
Ste B
Southampton, NY 11968
Phone (631) 287-9226

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871688556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 HAMPTON CT",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117271628",
            "telephone_number": "631-642-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 E MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012563",
            "telephone_number": "631-369-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHR",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "credential": "M.S.  CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "002094-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.