Active NPI
Mary R O'Donnell, R.P.A.-C.
- Medical Physician Assistant
- Woodbury, NY
National Provider Identifier
1982833307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 004014
- Practice address
- 80 Crossways Park Dr
Woodbury, NY 11797-2047 - Phone
- (631) 796-9488
- NPI assigned
- Jul 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 004014 | NY | Primary |
Addresses
Primary practice location
80 Crossways Park Dr
Woodbury, NY 11797-2047
Mailing address
791 N Wellwood Ave
Lindenhurst, NY 11757
Phone (631) 957-2200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004014 | NY | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New York Comptrollers Office | Current | Accepting new patients | |
| State of New York Comptrollers Office | Current | Accepting new patients | |
| Primary Urgent Medical PC | Past | Accepting new patients |
Locations
100 Patriots Rd
Stony Brook, NY 11790
Phone (631) 444-8500
Organizations & group practices 5
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.
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- Developmental Disabilities Clinic/Center
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- Internal Medicine Physician
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538006400000",
"number": "1982833307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "791 N WELLWOOD AVE",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "11757",
"telephone_number": "631-957-2200",
"fax_number": "631-957-4619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 CROSSWAYS PARK DR",
"city": "WOODBURY",
"state": "NY",
"postal_code": "117972047",
"telephone_number": "631-796-9488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DONNELL",
"first_name": "MARY",
"middle_name": "R",
"credential": "R.P.A.-C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-07",
"last_updated": "2018-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "004014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.