Mary Susan Shick, MSN, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71000080A Issued in IN

Practice address

421 W 1St St
Bloomington, IN 47403-2403

Phone

(812) 336-0168

Fax

(812) 335-7372

NPI assigned

Jun 28, 2006

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 1

Other names 1

• Mary Susan Watts Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1992733240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W 1ST ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032403",
            "telephone_number": "812-336-0168",
            "fax_number": "812-335-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W 1ST ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032403",
            "telephone_number": "812-336-0168",
            "fax_number": "812-335-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHICK",
        "first_name": "MARY",
        "middle_name": "SUSAN",
        "credential": "MSN, ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "IN",
            "license": "28090755A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71000080A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200076820A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshick@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "421 W 1st St",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474032403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WATTS",
            "middle_name": "SUSAN",
            "credential": "MSN, ANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sage Sherfick, RBT
• Sheridan Emergency Physician Services of Indiana, PC
• Roberta Sherman, PH.D.
• Erin L Sherrill
• Rongrong Shi, MT-BC
• Gal Shifron, LCSW
• Margo Frances Shine, EDS, BCBA
• Paige Shipley, RBT
• Devin Brant Shone, D.D.S.
• Diane Elaine Short, OD

• Adult Health Nurse Practitioner in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.

Verify at the official NPI Registry.