Individual provider Active NPI

Morgan Nicole Madison, M.D.

  • Family Medicine Physician
  • Oak Park, IL
National Provider Identifier
1265708069
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036137978 Issued in IL
Practice address
14 Lake St
Oak Park, IL 60302-2606
Phone
(708) 383-0113
NPI assigned
Mar 26, 2012
Last updated
Dec 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 125062272 IL
Family Medicine Physician 207Q00000X 036137978 IL Primary

Addresses

Primary practice location

14 Lake St
Oak Park, IL 60302-2606

Mailing address

1919 W Taylor St
M/C 663
Chicago, IL 60612-7246

Other practice location 1

1740 W Taylor St
Chicago, IL 60612-7232
Phone (866) 600-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150917002230 IL Practitioner - Family Practice 1951618388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
George Washington University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036137978ILMDFamily Medicine Physician
125062272ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Sep 16, 2015 Accepting new patients
PCC Community Wellness Center CurrentSince Sep 16, 2015 Accepting new patients
PCC Community Wellness Center Past Accepting new patients

Locations

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: morgan.madison.1@13158.direct.athenahealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1265708069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 W TAYLOR ST",
            "address_2": "M/C 663",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022606",
            "telephone_number": "708-383-0113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1740 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127232",
            "country_code": "US",
            "telephone_number": "866-600-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADISON",
        "first_name": "MORGAN",
        "middle_name": "NICOLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125062272",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036137978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.