NPIMap

Individual provider Active NPI

Mary Starr Schipper, MD

  • Pediatrics Physician
  • Las Vegas, NM
National Provider Identifier
1922189463
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
20030522 Issued in NM
Practice address
Las Vegas Clinic for Children & Youth
501 7TH Street
Las Vegas, NM 87701-3993
Phone
(505) 425-3566
Fax
(505) 425-3568
NPI assigned
Oct 18, 2006
Sex
Female
Sole proprietor
No

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 20030522 NM Primary
Pediatrics Physician 208000000X D0027946 MD
Pediatrics Physician 208000000X MD021090E PA
Pediatrics Physician 208000000X 12493 WV

Addresses

Primary practice location

Las Vegas Clinic for Children & Youth
501 7TH Street
Las Vegas, NM 87701-3993

Mailing address

2910 8TH Street
Las Vegas, NM 87701-3993
Phone (505) 425-2985

Other identifiers 1

IdentifierTypeStateIssuer
49395MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0027946MDMDPediatrics Physician
20030522NMMDPediatrics Physician
MD021090EPAMDPediatrics Physician
12493WVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Miguel Clinic Corp PastSince Jul 5, 2018 Accepting new patients
Las Vegas Clinic for Children & Youth Pediatrics Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922189463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 8TH STREET",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013993",
            "telephone_number": "505-425-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAS VEGAS CLINIC FOR CHILDREN & YOUTH",
            "address_2": "501 7TH STREET",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013993",
            "telephone_number": "505-425-3566",
            "fax_number": "505-425-3568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHIPPER",
        "first_name": "MARY",
        "middle_name": "STARR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "20030522",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0027946",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD021090E",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "12493",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49395",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.