NPIMap

Individual provider Active NPI

Mary Lynn Milam, FNP

  • Family Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1013956341
Registry record updated Dec 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP108194 Issued in TX
Practice address
301 40TH St
Lubbock, TX 79404-2746
Phone
(806) 743-9355
Fax
(806) 743-9363
NPI assigned
Jun 5, 2006
Last updated
Dec 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP108194 TX Primary

Addresses

Primary practice location

301 40TH St
Lubbock, TX 79404-2746

Mailing address

7722 Woodrow Rd
Wolfforth, TX 79382-5613
Phone (806) 863-2853

Other identifiers 2

IdentifierTypeStateIssuer
8Y3717OtherTXBCBS
9078128OtherTXAETNA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Senior.House@direct.myteamcare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080404000405 TX Practitioner - Nurse Practitioner 6901983683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 40TH St
Lubbock, TX 79404-2746
Phone (806) 743-9355

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center - Son - Lubbock CurrentSince Apr 26, 2016 Accepting new patients
Texas Tech University Health Sciences Center - Son - Lubbock Family CurrentSince Apr 26, 2016 Accepting new patients

Locations

301 40th St
Lubbock, TX 79404
Phone (806) 743-9355

Organizations & group practices 2

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576281600000",
    "number": "1013956341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7722 WOODROW RD",
            "city": "WOLFFORTH",
            "state": "TX",
            "postal_code": "793825613",
            "telephone_number": "806-863-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 40TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794042746",
            "telephone_number": "806-743-9355",
            "fax_number": "806-743-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILAM",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2019-12-14",
        "certification_date": "2019-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP108194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8Y3717",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9078128",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Senior.House@direct.myteamcare.com",
            "affiliation": "N",
            "endpointDescription": "SHC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 40th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794042746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.