NPIMap

Individual provider Active NPI

Angelique Madison, FNP

  • Family Nurse Practitioner
  • Watervliet, MI
National Provider Identifier
1417358995
Registry record updated Nov 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704253993 Issued in MI
Practice address
400 Medical Park Dr
Watervliet, MI 49098-9225
Phone
(269) 463-3600
NPI assigned
Sep 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704253993 MI Primary

Addresses

Primary practice location

400 Medical Park Dr
Watervliet, MI 49098-9225

Mailing address

6701 Paw Paw Ave
Coloma, MI 49038-9519
Phone (269) 463-3000

Other identifiers 1

IdentifierTypeStateIssuer
1417358995MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150218001341 MI Practitioner - Nurse Practitioner 9436474244 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

133 W Main St
Benton Harbor, MI 49022-3607
Phone (269) 408-2258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Lakeland Medical Practices CurrentSince Apr 28, 2025 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Jan 2, 2015 Accepting new patients
Lakeland Medical Practices CurrentSince Apr 28, 2025 Accepting new patients
Lakeland Community Hospital Watervliet Current Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Jan 2, 2015 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Jan 15, 2023 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Jan 15, 2023 Accepting new patients

Locations

100 W Main St
Benton Harbor, MI 49022
Phone (269) 408-2258

133 W Main St
Benton Harbor, MI 49022
Phone (269) 408-2258

6701 Paw Paw Ave
Coloma, MI 49038
Phone (269) 468-6430

7040 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-4318

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

460 Medical Park Dr
Ste 200
Watervliet, MI 49098

Interoperability endpoints

  • Direct secure messaging: amadison1270647@epic00.corewelldirect.org
  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

Organizations & group practices 8

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": "1410739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447372800000",
    "number": "1417358995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 PAW PAW AVE",
            "city": "COLOMA",
            "state": "MI",
            "postal_code": "490389519",
            "telephone_number": "269-463-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-463-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADISON",
        "first_name": "ANGELIQUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-15",
        "last_updated": "2015-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704253993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417358995",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watervliet, MI

Sources for this page

Verify at the official NPI Registry.