NPIMap

Individual provider Active NPI

Madetric Nafaye Wood, APRN-BC, GNP

  • Gerontology Nurse Practitioner
  • Fort Pierce, FL
National Provider Identifier
1073716650
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
ARNP9189379 Issued in FL
Practice address
5804 Indian Pines Blvd
Fort Pierce, FL 34951-2302
Phone
(772) 828-3752
Fax
(772) 302-3518
NPI assigned
Jun 9, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN9189379 FL
Gerontology Nurse Practitioner 363LG0600X ARNP9189379 FL Primary

Addresses

Primary practice location

5804 Indian Pines Blvd
Fort Pierce, FL 34951-2302

Mailing address

5804 Indian Pines Blvd
Fort Pierce, FL 34951-2302
Phone (772) 828-3752

Other identifiers 2

IdentifierTypeStateIssuer
2078100MedicaidFL
AF163ZOtherFLMEDICARE LEGACY NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100629000982 FL Practitioner - Nurse Practitioner 7113011396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5804 Indian Pines Blvd
Fort Pierce, FL 34951-2302
Phone (772) 203-1887

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN9189379FLMDRegistered Nurse
ARNP9189379FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric Solutions, LLC Gerontology CurrentSince Apr 30, 2003 Accepting new patients
Long Term Care Nurse Practitioner Services, LLC Past Accepting new patients

Locations

5804 Indian Pines Blvd
Fort Pierce, FL 34951
Phone (772) 203-1887

3663 15th Ave
Vero Beach, FL 32960
Phone (772) 567-2552

Interoperability endpoints

  • Direct secure messaging: madetric.wood.1@17433.direct.athenahealth.com
  • Direct secure messaging: madetric.wood@25550860058628.direct.elationemr.com

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1181347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1073716650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5804 INDIAN PINES BLVD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349512302",
            "telephone_number": "772-828-3752",
            "fax_number": "772-302-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5804 INDIAN PINES BLVD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349512302",
            "telephone_number": "772-828-3752",
            "fax_number": "772-302-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "MADETRIC",
        "middle_name": "NAFAYE",
        "name_prefix": "Mrs.",
        "credential": "APRN-BC, GNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-09",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9189379",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "ARNP9189379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2078100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY NUMBER",
            "identifier": "AF163Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.