Madalyn Rae Gold Amis, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Lewisburg, TN
NPI 1396427993 · NPPES record last updated Aug 2, 2023
Key facts
- NPI
- 1396427993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 34394 (TN)
- Practice address
- 1090 N Ellington Pkwy Ste 102
Lewisburg, TN 37091-2227 - Phone
- (931) 359-0019
- NPI assigned
- Aug 2, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Maury Regional Hospital
Practice addresses (Care Compare)
1090 N Ellington Pkwy
Suite 102
Lewisburg, TN 37091-2227
Phone (931) 359-0019
Hospital & facility affiliations
- Marshall Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231121000947 | TN | Practitioner - Nurse Practitioner | 9133577760 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34394 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maury Regional Hospital | Current |
Accepting new patients | |
| Maury Regional Hospital | Current | Accepting new patients | |
| Maury Regional Hospital | Current |
Accepting new patients | |
| Maury Regional Hospital | Current | Accepting new patients |
Locations
617 W Main St
Hohenwald, TN 38462
Phone (931) 796-4901
1090 N Ellington Pkwy
Ste 102
Lewisburg, TN 37091
Phone (931) 359-0019
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 34394 | TN | Yes |
Addresses
Primary practice location
1090 N Ellington Pkwy Ste 102
Lewisburg, TN 37091-2227
Mailing address
1090 N Ellington Pkwy Ste 102
Lewisburg, TN 37091-2227
Phone (931) 359-0019
Other names
- Madalyn Rae Gold
Other providers in Lewisburg, TN
- Air Evac EMS Inc
- Aj Medical Services, Inc
- David Alfredson
- Randall Lee Allen
- Amg-Hillside LLC
- Tia Nicole Anderson
- Angela Wiles Psychiatry
- Ankle and Foot Centers of Nashville, PLLC
- Ankle and Foot Centers of Nashville, PLLC
- Heather Kelly Arnett
All providers in Lewisburg, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.