MRS. MARY THERESA WILD CREA M.D.
NPI 1982604096
Specialist in Inver Grove Heights, MN

Q: What is Mary Wild Crea's NPI number?

The NPI number for Mary Wild Crea is 1982604096. It was assigned to this individual provider in the NPPES registry on July 29, 2005.

Q: What is Mary Wild Crea's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Wild Crea was last updated on July 13, 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.

Active since July 29, 2005PECOS Enrolled

5975 CARMEN AVE, INVER GROVE HEIGHTS, MN 55076(651) 455-9697(651) 455-2012 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Mrs. Mary Theresa Wild Crea M.d. NPPES

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

MRS. MARY THERESA WILD CREA M.D. (NPI 1982604096) is an individual specialist in Inver Grove Heights, Minnesota, licensed in Minnesota (38767) and active in the NPI registry since July 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1982604096

Entity TypeIndividualFemale

Primary Taxonomy174400000X

Provider Legal NameMRS. MARY THERESA WILD CREACredential: M.D.

Location Address5975 CARMEN AVEInver Grove Heights, MN 55076-4416

Mailing Address1286 Raymond AveSaint Paul, MN 55108-1820 · (651) 455-9697 · Fax (651) 455-2012

Phone(651) 455-9697

Fax(651) 455-2012

Sole ProprietorNo

Enumeration DateJuly 29, 2005

Last NPPES UpdateJuly 13, 2026

✔ NPI 1982604096 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in MN · 38767

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

5975 CARMEN AVE, Inver Grove Heights, MN 55076

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Mary Theresa Wild Crea M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Mary Wild Crea reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Fairview Clinics

6.6 mi

Primary Care

45 10TH ST W
Saint Paul, MN 55102

Reassigned Medicare billing, Minnesota enrollment
2,302 clinicians in this Medicare group

NPI 1396552147 (651) 232-4990

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 7

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

MRS. LAUREL RUTH ANDERSON M.D.

Specialist