Active NPI
Mary Theresa James, CNP
- Family Medicine Physician
- Andover, OH
National Provider Identifier
1992786917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- NP 08421
- Practice address
- 149 E Main St
Andover, OH 44003-9479 - Phone
- (440) 293-5555
- Fax
- (440) 293-6643
- NPI assigned
- Nov 8, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NP 08421 | OH | Primary |
Addresses
Primary practice location
149 E Main St
Andover, OH 44003-9479
Mailing address
149 E Main St
Andover, OH 44003-9479
Phone (440) 293-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2615450 | Medicaid | OH |
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP 08421 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1992786917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "149 E MAIN ST",
"city": "ANDOVER",
"state": "OH",
"postal_code": "440039479",
"telephone_number": "440-293-5555",
"fax_number": "440-293-6643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "149 E MAIN ST",
"city": "ANDOVER",
"state": "OH",
"postal_code": "440039479",
"telephone_number": "440-293-5555",
"fax_number": "440-293-6643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMES",
"first_name": "MARY",
"middle_name": "THERESA",
"name_prefix": "Mrs.",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-08",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "NP 08421",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2615450",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Andover, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; 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.