MARY WISBON MD
NPI 1770110124
Pediatrics - Pediatric Emergency Medicine in Houston, TX

Active since March 25, 2020PECOS EnrolledAccepts Medicare Assignment
6621 FANNIN ST, HOUSTON, TX 77030(832) 824-1170 Get Directions Write a Review

NPPES record last updated: July 2, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mary Wisbon Md NPPES

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

MARY WISBON MD (NPI 1770110124) is an individual pediatric emergency medicine provider in Houston, Texas, licensed in Texas (U3382) and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS and is a graduate of University Of New Mexico School Of Medicine (2020).

NPPES Registry Identity

NPI1770110124
Entity TypeIndividualFemale
Primary Taxonomy2080P0204X
Provider Legal NameMARY WISBONCredential: MD
Location Address6621 FANNIN STHouston, TX 77030-2358
Mailing Address1 Baylor Plz # Bcm320Houston, TX 77030-3411
Sole ProprietorNo
Medical School CMSUniversity Of New Mexico School Of MedicineGraduated 2020
Enumeration DateMarch 25, 2020
Last NPPES UpdateJuly 2, 2026
NPPES CertifiedJuly 2, 2026
NPI 1770110124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080P0204X
License Licensed in TX · U3382
Definition
A pediatrician who has special qualifications to manage emergencies in infants and children.
Also ListedPediatricsTaxonomy 208000000X · License U3382 (TX)
6621 FANNIN ST, Houston, TX 77030

Accepted 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 Wisbon Md 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 ID1759860299
PECOS Enrollment IDI20260205001607
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.

Other Providers at the Same Location NPPES 20

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

Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Physical Therapist
6621 FANNIN ST
HOUSTON, TX 77030
Physician Assistant
6621 FANNIN ST
HOUSTON, TX 77030
Anesthesiology
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Endocrinology)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Hematology-Oncology)
6621 FANNIN ST, MC 3-3320
HOUSTON, TX 77030

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 Wisbon's NPI number?

The NPI number for Mary Wisbon is 1770110124. It was assigned to this individual provider in the NPPES registry on March 25, 2020.

Where is Mary Wisbon located?

Mary Wisbon practices at 6621 Fannin St, Houston, TX 77030. The listed phone number is (832) 824-1170.

What is Mary Wisbon's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.

Is Mary Wisbon enrolled in Medicare?

Yes. Mary Wisbon 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.

What insurance does Mary Wisbon accept?

Health plans from Moda Health Plan, Inc. list Mary Wisbon 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 Wisbon was last updated on July 2, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.