NPIMap

Individual provider Active NPI

Mary Katherine Yoder, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1891901674
Registry record updated Jun 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101242688 Issued in VA
Practice address
4205 Belfort Rd
Suite 3075
Jacksonville, FL 32216-1475
Phone
(904) 308-7790
Fax
(904) 296-4786
NPI assigned
May 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101242688 VA Primary
Family Medicine Physician 207Q00000X ME 106212 FL

Addresses

Primary practice location

4205 Belfort Rd
Suite 3075
Jacksonville, FL 32216-1475

Mailing address

4205 Belfort Rd
Suite 3075
Jacksonville, FL 32216-1475
Phone (904) 308-7790

Other names 1

  • Mary Katherine Von Herrmann Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20101006000957 FL Practitioner - Family Practice 7719041839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Florida College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent'S Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians

Practice addresses (Care Compare)

4205 Belfort Rd
Suite 3075
Jacksonville, FL 32216-1475
Phone (904) 308-7790

Hospital & facility affiliations

  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Ascension St Vincent'S Southside Hospital, Jacksonville, FL, CCN 100307
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Ascension St Vincent'S St Johns County Hospital, St. Johns, FL, CCN 100361
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 106212FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Jul 1, 2014 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 1, 2014 Accepting new patients

Locations

9560 Crosshill Blvd
Ste 110
Jacksonville, FL 32222
Phone (904) 203-1296

4205 Belfort Rd
Ste 3075
Jacksonville, FL 32216
Phone (904) 296-5785

2627 Riverside Ave
Jacksonville, FL 32204
Phone (904) 308-7372

Interoperability endpoints

  • Direct secure messaging: mary.yoder.1@8967.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1891901674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "SUITE 3075",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161475",
            "telephone_number": "904-308-7790",
            "fax_number": "904-296-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "SUITE 3075",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161475",
            "telephone_number": "904-308-7790",
            "fax_number": "904-296-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YODER",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101242688",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 106212",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "VON HERRMANN",
            "middle_name": "KATHERINE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.