Mary Maureen Boren, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

71610-20 Issued in WI

Practice address

8375 S Howell Ave
Oak Creek, WI 53154-8344

Phone

(414) 764-5726

Fax

(414) 764-6954

NPI assigned

Jun 19, 2014

Last updated

Jun 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary M Longo Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboren93844@direct.chw.org

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.

• Columbia St. Mary's Hospital Milwaukee, Inc

  dba Ascension Columbia St Mary's Hospital Milwaukee

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1023064482
  Medicare reassignment NPD
• Columbia St. Mary's Hospital Milwaukee Inc

  dba Ascension Columbia St Mary's Hospital Ozaukee

  • Psychiatric Hospital Unit
  • Mequon, WI
  • NPI 1417600909
  NPD
• Columbia St. Mary's Hospital Milwaukee, Inc

  dba Ascension Columbia St Mary's Hospital Milwaukee

  • Multi-Specialty Clinic/Center
  • Glendale, WI
  • NPI 1215945456
  NPD
• Children's Medical Group

  dba Glendale Pediatrics

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)
• Children's Medical Group

  dba Lakeside Pediatrics

  • Pediatrics Physician
  • Kenosha, WI
  • NPI 1427223783
  NPD (past)

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1881008738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8375 S HOWELL AVE",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548344",
            "telephone_number": "414-764-5726",
            "fax_number": "414-764-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8375 S HOWELL AVE",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548344",
            "telephone_number": "414-764-5726",
            "fax_number": "414-764-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOREN",
        "first_name": "MARY",
        "middle_name": "MAUREEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-19",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "71610-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881008738",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "LONGO",
            "middle_name": "M",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard L. Bigalk, P.T.
• Jessica Bisgrove Mahn, O.D.
• Rachel Blaskowski
• Blue Pearl Institute LLC
• Margaret Bolek, DDS
• Anna Boteva
• Mina Botros, DC
• Nader Y Botros, R.PH
• Dana L Bott, DDS
• Sharon Boushon

• Pediatrics Physician in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.