DR. MARY K PENDERGRASS DO
NPI 1457616872
Family Medicine in West Plains, MO
About Dr. Mary K Pendergrass Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MARY K PENDERGRASS DO (NPI 1457616872) is an individual family medicine provider in West Plains, Missouri, licensed in Missouri (2014030982) and active in the NPI registry since July 2012. She is enrolled in Medicare PECOS, maintains a secondary practice location in Willow Springs, and is a graduate of Other (2011).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Mary K Pendergrass Do 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.
Medicare Billing Reassignment
Medicare enrollment records show Mary Pendergrass reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Cabool, MO 65689
- Reassigned Medicare billing, Missouri enrollment
- 32 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 65775 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WEST PLAINS, MO 65775
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mary Pendergrass's NPI number?
The NPI number for Mary Pendergrass is 1457616872. It was assigned to this individual provider in the NPPES registry on July 11, 2012.
Where is Mary Pendergrass located?
Mary Pendergrass practices at 181 N Kentucky Ave Ste 100, West Plains, MO 65775. The listed phone number is (417) 257-5911.
What is Mary Pendergrass's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Mary Pendergrass enrolled in Medicare?
Yes. Mary Pendergrass is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Mary Pendergrass's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Pendergrass reassigns Medicare benefits to Douglas County Public Health Services Group, Inc. (Cabool, MO). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Pendergrass's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mary Pendergrass accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 4 other insurers list Mary Pendergrass as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mary Pendergrass was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Dr. Mary K Pendergrass, DO · NPI 1457616872
Family Medicine physician in West Plains, Missouri. Individual provider, active in the CMS NPPES registry since July 11, 2012.
## Identity
- **NPI:** 1457616872 (Entity type: Individual)
- **Enumerated:** July 11, 2012
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 2014030982 (Missouri)
- **Sole proprietor:** No
## Practice location
- **Address:** 181 N KENTUCKY AVE STE 100, West Plains, MO 65775-2092
- **Phone:** (417) 257-5911
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Douglas County Public Health Services Group, Inc. (NPI 1710221130, Cabool, MO), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2011
## Record status
- **NPPES last updated:** July 21, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1457616872) · Data from the CMS NPPES public registry.