Mary Elizabeth Schustek, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

006357 Issued in CT

Practice address

67 Masonic Ave
Suite 3100
Wallingford, CT 06492-3095

Phone

(203) 284-3144

Fax

(203) 284-3140

NPI assigned

Aug 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Mrs. Mary Elizabeth Doolittle Former name

Medicare fee-for-service enrollment

Enrolled in SC, WV2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  SC, WV

  Medicare reassignment NPD
• Executive Court Medical Associates Inc.

  • Family Medicine Physician
  • Norwalk, OH
  • NPI 1184794885
  NPD (past)
• James M Vest MD PC

  • Family Medicine Physician
  • Surfside Beach, SC
  • NPI 1710065941
  NPD (past)
• James M. Vest, MD PC

  • Family Medicine Physician
  • Surfside Beach, SC
  • NPI 1013066042
  NPD (past)
• Rivertown Primary Medical

  • Family Medicine Physician
  • Conway, SC
  • NPI 1770692808
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1891705307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MASONIC AVE",
            "address_2": "SUITE 3100",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923095",
            "telephone_number": "203-284-3144",
            "fax_number": "203-284-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 MASONIC AVE",
            "address_2": "SUITE 3100",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923095",
            "telephone_number": "203-284-3144",
            "fax_number": "203-284-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUSTEK",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Miss",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "2742",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "APN2742",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "006357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0948",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "Q42721179",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DOOLITTLE",
            "middle_name": "ELIZABETH",
            "prefix": "MRS.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Derrick R. Schull II, N.D.
• Eugene Schulze, PH.D.
• Schupack Family Dentistry PLLC
• Alan David Schupack, DDS
• Rebecca Lauren Schupack, DDS
• Kerryann Scirocco
• Dorene Scolnic, LCSW
• Duane Scotti
• Tami Scotto, OTR
• Cecilia Catherine Segura, LCSW

• Family Nurse Practitioner in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; 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.