MARY WISBON MD
NPI 1770110124
Pediatrics - Pediatric Emergency Medicine in Houston, TX
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
Specialties & Licenses 2
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
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.
Medicare Billing Reassignment
Medicare enrollment records show Mary Wisbon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Houston, TX 77030
- Reassigned Medicare billing, Texas enrollment
- Medicare enrollment name: Texas Childrens Physician Group
- 2,498 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.
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.
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.
Which organization bills Medicare for Mary Wisbon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Wisbon reassigns Medicare benefits to Texas Children's Physician Group (Houston, TX). 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 Wisbon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.
# Mary Wisbon, MD · NPI 1770110124
Pediatric Emergency Medicine physician in Houston, Texas. Individual provider, active in the CMS NPPES registry since March 25, 2020.
## Identity
- **NPI:** 1770110124 (Entity type: Individual)
- **Enumerated:** March 25, 2020
- **Primary specialty:** Pediatrics - Pediatric Emergency Medicine · taxonomy 2080P0204X
- **State license:** U3382 (Texas)
- **Sole proprietor:** No
## Practice location
- **Address:** 6621 FANNIN ST, Houston, TX 77030-2358
- **Phone:** (832) 824-1170
## 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:** Texas Children's Physician Group (NPI 1861675506, Houston, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of New Mexico School Of Medicine, class of 2020
## Record status
- **NPPES last updated:** July 2, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1770110124) · Data from the CMS NPPES public registry.