Individual provider Active NPI

Maggie Jane Impastato, MSN,RN, AGACNP-BC

  • Nurse Practitioner
  • Waco, TX
National Provider Identifier
1174047120
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP134711 Issued in TX
Practice address
100 Hillcrest Medical Blvd
Waco, TX 76712-8897
Phone
(254) 202-2000
NPI assigned
Aug 1, 2017
Last updated
Dec 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP134711 TX Primary
Acute Care Nurse Practitioner 363LA2100X 9223 WI
Internal Medicine Physician 207R00000X AP134711 TX

Addresses

Primary practice location

100 Hillcrest Medical Blvd
Waco, TX 76712-8897

Mailing address

PO Box 848491
Dallas, TX 75284-8491
Phone (254) 202-9330

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpetrey34358@direct.sw.org Direct

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171010001705 TX Practitioner - Nurse Practitioner 2668747171 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hillcrest Physician ServicesGroup PAC ID 1153304456, 114 clinicians

Practice addresses (Care Compare)

100 Hillcrest Med Blvde
Waco, TX 76712-8897
Phone (254) 202-2000

140 Hillcrest Medical Blvd
Waco, TX 76712-8897

150 Hillcrest Medical Blvd
Waco, TX 76712-8897
Phone (254) 202-4000

50 Hillcrest Medical Blvd
Suite 206
Waco, TX 76712-8954
Phone (254) 202-7950

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP134711TXMDNurse Practitioner
9223WIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hillcrest Physician Services Single Specialty CurrentSince Aug 21, 2017 Accepting new patients
Cogent Healthcare of Texas, PA Single Specialty CurrentSince Apr 1, 2022 Accepting new patients
Scott & White Hospital - Taylor Single Specialty Past Accepting new patients

Locations

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

919 E 32nd St
Austin, TX 78705
Phone (512) 343-2466

8200 Walnut Hill Ln
Dallas, TX 75231
Phone (214) 345-6148

2400 Round Rock Ave
Round Rock, TX 78681
Phone (512) 255-6066

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

100 Hillcrest Medical Blvd
Waco, TX 76712
Phone (254) 202-2000

50 Hillcrest Medical Blvd
Waco, TX 76712
Phone (254) 202-7300

Interoperability endpoints

  • Direct secure messaging: mpetrey34358@direct.sw.org

Organizations & group practices 3

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 1

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": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1174047120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848491",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752848491",
            "telephone_number": "254-202-9330",
            "fax_number": "254-202-9349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HILLCREST MEDICAL BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128897",
            "telephone_number": "254-202-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMPASTATO",
        "first_name": "MAGGIE",
        "middle_name": "JANE",
        "credential": "MSN,RN, AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP134711",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WI",
            "license": "9223",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "AP134711",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpetrey34358@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Hillcrest Medical Blvd",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767128897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.