NPIMap

Individual provider Active NPI

Mary Lynne De Paz Lucido, MD

  • Gastroenterology Physician
  • Minneapolis, MN
National Provider Identifier
1952354995
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
45039 Issued in MN
Practice address
701 Park Ave
P5
Minneapolis, MN 55415-1623
Phone
(612) 873-2300
NPI assigned
May 19, 2006
Last updated
Jul 17, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 45039 MN Primary

Addresses

Primary practice location

701 Park Ave
P5
Minneapolis, MN 55415-1623

Mailing address

14437 Maple Stree
Overland Park, KS 66223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070615000313 MO Practitioner - Internal MedicinePractitioner - Gastroenterology 9931103215 Reassigns benefits to 1 organization
I20230925000276 KS Practitioner - GastroenterologyPractitioner - Internal Medicine 9931103215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Missouri, Kansas City, School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health Specialists LLCGroup PAC ID 9739494832, 69 clinicians

Practice addresses (Care Compare)

10787 Nall Ave
100 College Park Surgicenter
Overland Park, KS 66211-1373
Phone (816) 554-3838

110 NE Saint Lukes Blvd
Suite 530
Lees Summit, MO 64086-6075
Phone (816) 554-3838

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy152
Upper gastrointestinal (GI) endoscopy for acid reflux142

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Digestive Health Specialists, LLC Gastroenterology CurrentSince Oct 1, 2015 Accepting new patients
Hennepin Healthcare System, Inc Past Accepting new patients
Hennepin Faculty Associates Past Accepting new patients

Locations

10787 Nall Ave
Ste 100
Overland Park, KS 66211
Phone (913) 312-3710

7820 W 165th St
Overland Park, KS 66223
Phone (913) 232-9846

615 W Nursery St
Butler, MO 64730
Phone (660) 200-2004

17501 E US Highway 40
Ste 213A
Independence, MO 64055
Phone (816) 478-7887

3800 S Whitney Ave
Ste 100
Independence, MO 64055

110 NE Saint Lukes Blvd
Ste 530
Lees Summit, MO 64086

120 NE Saint Lukes Blvd
#275
Lees Summit, MO 64086

4510 Frederick Ave
Saint Joseph, MO 64506
Phone (816) 233-1629

11525 Olde Cabin Rd
Saint Louis, MO 63141
Phone (314) 997-0554

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
BJC HealthcareLees Summit, MO, CCN 260216 Hospital Corporate Director Jan 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1952354995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14437 MAPLE STREE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "66223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "address_2": "P5",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCIDO",
        "first_name": "MARY LYNNE",
        "middle_name": "DE PAZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "45039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.