Individual provider Active NPI

Madison Whitehead, PA-C

  • Physician Assistant
  • Farmington, NM
National Provider Identifier
1366123390
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2023-0254 Issued in NM
Practice address
407 S Schwartz Ave Ste 101
Farmington, NM 87401-5925
Phone
(505) 609-6595
NPI assigned
Jul 31, 2023
Last updated
Aug 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X PA2023-0254 NM Primary

Addresses

Primary practice location

407 S Schwartz Ave Ste 101
Farmington, NM 87401-5925

Mailing address

532 Doubletree Dr
Highland Village, TX 75077-6968
Phone (214) 208-9757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20231106000869 NM Practitioner - Physician Assistant 4688021199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

407 S Schwartz Ave
Farmington, NM 87401-5925

801 W Maple St
Farmington, NM 87401-5630

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.97 of 100Reported as group
Quality
79.73
Promoting interoperability
100
Improvement activities
40
Cost
78.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
San Juan Regional Medical Center Inc CurrentSince Oct 10, 2023 Accepting new patients
San Juan Regional Medical Center Inc CurrentSince Oct 10, 2023 Accepting new patients

Locations

407 S Schwartz Ave
Ste 101
Farmington, NM 87401
Phone (505) 609-6595

4820 E Main St
Ste 2
Farmington, NM 87402
Phone (505) 609-6610

801 W Maple St
Farmington, NM 87401
Phone (505) 325-5011

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 2

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": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1366123390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 DOUBLETREE DR",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750776968",
            "telephone_number": "214-208-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S SCHWARTZ AVE STE 101",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015925",
            "telephone_number": "505-609-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "MADISON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2023-0254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

Verify at the official NPI Registry.