Mary Jane Maun-Viduya, PA
Individual provider Active NPI Physician Assistant · Shafter, CA
NPI 1962663005 · NPPES record last updated Dec 22, 2011
Key facts
- NPI
- 1962663005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA19777 (CA)
- Practice address
- 655 S Central Valley Hwy
Shafter, CA 93263-2790 - Phone
- (661) 746-9194
- Fax
- (661) 746-9197
- NPI assigned
- Jun 20, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Vanguard Medical Corporation
Practice addresses (Care Compare)
565 Kern St
Shafter, CA 93263-2133
Phone (661) 746-4937
841 7TH St
Wasco, CA 93280-1919
Phone (661) 459-1001
845 7TH St
Wasco, CA 93280-1919
Phone (661) 459-1000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091216000402 | CA | Practitioner - Physician Assistant | 1557401999 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19777 | CA | MD | Obstetrics & Gynecology Physician |
Practice roles (6 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vanguard Medical Corporation | Current |
Accepting new patients | |
| Vanguard Medical Corporation | Current |
Accepting new patients | |
| Omni Family Health | Past | Accepting new patients | |
| Jae J. Kim, M.D. | Past | Accepting new patients | |
| Central California Emergency Medicine Physicians | Past | Accepting new patients | |
| Bakersfield Memorial Hospital | Past | Accepting new patients |
Locations
565 Kern St
Shafter, CA 93263
Phone (661) 746-4937
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA19777 | CA | Yes |
Addresses
Primary practice location
655 S Central Valley Hwy
Shafter, CA 93263-2790
Mailing address
659 S Central Valley Hwy
P.O. Box 1060
Shafter, CA 93263-2790
Phone (661) 459-1900
Other providers in Shafter, CA
- Mirka Lopez
- Zachary Michael Luce
- Jelita Macanas
- Isis Samanta Macias Moreno
- Maple Elementary School District
- Avery McManus
- Debra Ann Metter
- Michael Komin MD Medical Corportion
- Brittany Millwee
- Julia Montoya
All providers in Shafter, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.