MARY EDEM NP
NPI 1760787030
Nurse Practitioner - Psychiatric/Mental Health in San Bernardino, CA

Q: What is Mary Edem's NPI number?

The NPI number for Mary Edem is 1760787030. It was assigned to this individual provider in the NPPES registry on January 18, 2011.

Q: What is Mary Edem's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Mary Edem was last updated on September 23, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 January 18, 2011PECOS EnrolledAccepts Medicare Assignment

190 E HIGHLAND AVE, SAN BERNARDINO, CA 92404(909) 882-4788(877) 860-7268 Get Directions Write a Review

NPPES record last updated: September 23, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 23, 2016, Sep 17, 2016, Dec 1, 2015 (3 updates tracked since 2015).

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About Mary Edem Np NPPES

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

MARY EDEM NP (NPI 1760787030) is an individual psychiatric/mental health provider in San Bernardino, California, licensed in California (20107) and active in the NPI registry since January 2011. She is enrolled in Medicare PECOS and is a graduate of Other (2010).

NPPES Registry Identity

NPI1760787030

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMARY EDEMCredential: NP

Location Address190 E HIGHLAND AVESan Bernardino, CA 92404-3658

Mailing Address200 Oceangate, Suite 100Long Beach, CA 90802-4317 · (562) 499-6191 · Fax (562) 499-6171

Phone(909) 882-4788

Fax(877) 860-7268

Sole ProprietorNo

Medical School CMSOtherGraduated 2010

Enumeration DateJanuary 18, 2011

Last NPPES UpdateSeptember 23, 20163 updates tracked since enumeration

✔ NPI 1760787030 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in CA · 20107

190 E HIGHLAND AVE, San Bernardino, CA 92404

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Other Identifiers 2

Medicare PINCA205848-CA109020CA

Medicare PINCA205847-GA222ACA

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

Mary Edem Np 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 ID9830491737

PECOS Enrollment IDI20160108002574

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.

Medicare Billing Reassignments

Medicare enrollment records show Mary Edem reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Inland Psychiatric Medical Group, Inc.

2.2 mi

Psychiatry

2372 STERLING AVE
San Bernardino, CA 92404

Reassigned Medicare billing, California enrollment
194 clinicians in this Medicare group

NPI 1841853330 (909) 887-6222

Ehab Yacoub MD Inc.

61 mi

Child & Adolescent Psychiatry

1225 W 190TH ST STE 280
Gardena, CA 90248

Reassigned Medicare billing, California enrollment
375 clinicians in this Medicare group

NPI 1417373713 (310) 515-8113

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 92404 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

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$104.64 typical visit price

range $19.37 – $146.42

Typical copayment $26.16 (range $4.84 – $36.60)

Most-billed visit code 99214

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 16

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

MIGUEL ANGEL IBARRA

Licensed Vocational Nurse