Mary Ellen McIntire, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

47600 Issued in AZ

Practice address

111 W Cedar LN Ste a
Payson, AZ 85541-5417

Phone

(928) 472-4675

Fax

(928) 472-3431

NPI assigned

Jul 4, 2006

Last updated

Oct 3, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443830400000",
    "number": "1982634028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W CEDAR LN STE A",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415417",
            "telephone_number": "928-472-4675",
            "fax_number": "928-472-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W CEDAR LN STE A",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415417",
            "telephone_number": "928-472-4675",
            "fax_number": "928-472-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTIRE",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2015-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "47600",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "36832",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TLC",
            "identifier": "31273",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3891205",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "863437",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00183551",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susie Renee McCartney-Belcher
• Benjamin D McDowell, D.D.S.
• Michael Vernon McEntire II, LPC
• William Joseph McEntyre, DO
• Debbie Alaina McGinn, D.O.
• Ivan Dale McLaws, D.P.M.
• Kelsi Marie McMartin, M.A., LMFT
• Brooke McPhee, CRNA
• Mettamerica
• Patsy Meyers, CRNA

• Family Medicine Physician in Payson, AZ
• Providers in Payson, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2015; 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.