Amy Michelle Medalie, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

6037 Issued in CO

Practice address

4405 River Oaks Blvd
Fort Worth, TX 76114-2326

Phone

(817) 624-1770

Fax

(817) 625-1287

NPI assigned

Jul 8, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amy Michelle Medalie Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: amedalie15514@cookchildrens.direct-ci.com
• FHIR API: https://api.platform.athenahealth.com/21038/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment
• Green Mountain Pediatrics

  • Pediatrics Physician
  • Lakewood, CO
  • NPI 1669499489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1003045204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 RIVER OAKS BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761142326",
            "telephone_number": "817-624-1770",
            "fax_number": "817-625-1287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 Union Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802281833",
            "country_code": "US",
            "telephone_number": "303-936-7415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDALIE",
        "first_name": "AMY",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CO",
            "license": "6037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amedalie15514@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "255 Union Blvd Ste 120",
            "city": "Lakewood",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802281833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amedalie15514@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "4405 River Oaks Blvd",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761142326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "MEDALIE",
            "middle_name": "MICHELLE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Med Southwest, PLLC
• Med Southwest, PLLC
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• Med Southwest, PLLC
• Med Southwest, PLLC
• Medalife Care Transport
• Medalife Care Transport
• Medall, Inc.
• Heidi L Medcalf, PA
• Medcare Diagnostics of America

• Pediatric Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.