Individual provider Active NPI

Elizabeth N Modene, NP

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1184132797
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP113012 Issued in TX
Practice address
11937 US Highway 271
Tyler, TX 75708-3154
Phone
(903) 877-7200
NPI assigned
Jan 17, 2018
Last updated
Apr 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 701932 TX
Family Nurse Practitioner 363LF0000X AP113012 TX Primary

Addresses

Primary practice location

11937 US Highway 271
Tyler, TX 75708-3154

Mailing address

11937 US Highway 271
Tyler, TX 75708-3154
Phone (903) 877-7200

Other practice location 1

8941 Coit Rd Ste 100
Plano, TX 75024-7731
Phone (972) 668-2200

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
I20230501000551 TX Practitioner - Nurse Practitioner 9931564713 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)

11937 US Hwy 271
Tyler, TX 75708-3154
Phone (903) 877-7200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
701932TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince Apr 1, 2023 Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Apr 1, 2023 Accepting new patients
Allergy and Asthma Center Adults and Children P LLC Past Accepting new patients

Locations

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

Interoperability endpoints

  • Direct secure messaging: emodene867731@ahs.direct-ci.com

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 3

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": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1184132797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8941 Coit Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750247731",
            "country_code": "US",
            "telephone_number": "972-668-2200",
            "fax_number": "972-668-2206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODENE",
        "first_name": "ELIZABETH",
        "middle_name": "N",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "701932",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP113012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.