MARY SHENOUDA M.D.
NPI 1104801976
Ophthalmology in Lake City, FL

Q: What is Mary Shenouda's NPI number?

The NPI number for Mary Shenouda is 1104801976. It was assigned to this individual provider in the NPPES registry on December 14, 2005.

Q: What is Mary Shenouda's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Shenouda was last updated on December 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 14, 2005PECOS EnrolledAccepts Medicare Assignment

1615 SW MAIN BLVD, LAKE CITY, FL 32025(386) 755-2785(386) 755-1128 Get Directions Write a Review

NPPES record last updated: December 14, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 14, 2023, May 10, 2021, Oct 15, 2020 and 2 more (5 updates tracked since 2019).

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About Mary Shenouda M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY SHENOUDA M.D. (NPI 1104801976) is an individual ophthalmology provider in Lake City, Florida, licensed in Florida (ME165007) and active in the NPI registry since December 2005. She is enrolled in Medicare PECOS, maintains a secondary practice location in Defiance, and is a graduate of Loyola University Of Chicago, Stritch School Of Medicine (2001).

NPPES Registry Identity

NPI1104801976

Entity TypeIndividualFemale

Primary Taxonomy207W00000X

Provider Legal NameMARY SHENOUDACredential: M.D.

Location Address1615 SW MAIN BLVDLake City, FL 32025-1108

Mailing AddressPo Box 489Lake City, FL 32056-0489 · (386) 755-2785

Phone(386) 755-2785

Fax(386) 755-1128

Sole ProprietorNo

Medical School CMSLoyola University Of Chicago, Stritch School Of MedicineGraduated 2001

Enumeration DateDecember 14, 2005

Last NPPES UpdateDecember 14, 20235 updates tracked since enumeration

NPPES CertifiedDecember 14, 2023

✔ NPI 1104801976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians

Taxonomy Code207W00000X

Licenses✔ Licensed in FL · ME165007✔ Licensed in IN · 01060074A✔ Licensed in OH · 88852

Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

1615 SW MAIN BLVD, Lake City, FL 32025

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Secondary Practice Location 1

Location 11252 Ralston Ave Ste 400Defiance, OH 43512-1480 · Phone (419) 782-6588 · Fax (419) 784-3622

Other Identifiers 1

Medicaid2713460OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Shenouda M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325093164

PECOS Enrollment IDI20231212002376

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient problem focused exam of visual system 92012

This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.

159 services80 patients

Imaging of retina 92134

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

95 services86 patients

Established patient complete exam of visual system 92014

An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.

94 services84 patients

New patient complete exam of visual system 92004

A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.

61 services61 patients

Exam of visual field with extended testing 92083

An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.

38 services36 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

35 services35 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32025 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$130.04 typical visit price

range $56.00 – $171.84

Typical copayment $32.51 (range $14.00 – $42.96)

Most-billed visit code 99204

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KARL D BODENDORFER MD

Ophthalmology