Penny J Mader, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

13327156-4405 Issued in UT

Practice address

1055 N 500 W
Attn Credentialing
Provo, UT 84604

Phone

(801) 354-8225

Fax

(801) 418-0941

NPI assigned

Aug 19, 2011

Last updated

May 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM, TX, UT, AZ4 enrollments

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 4

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians Southwest PCGroup PAC ID 2264538529, 96 clinicians

Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pmader49062@direct.phs.org

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.

• Emergency Physicians Southwest, PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1912053752

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Presbyterian Healthcare Services

  dba Presbyterian Medical Group

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1104802354
  Medicare reassignment Care Compare group NPD
• Kane County Human Resource Special Service District

  dba Kane County Hospital

  • General Acute Care Hospital
  • Kanab, UT
  • NPI 1043380991
  Medicare reassignment NPD
• DHHS PHS Naihs Crownpoint Hospital

  • General Acute Care Hospital
  • Crownpoint, NM
  • NPI 1114960093

  TX

  Medicare reassignment NPD
• Kane County Human Resource Special Service District

  dba Stonehenge of Springville

  • Skilled Nursing Facility
  • Springville, UT
  • NPI 1063401750
  NPD
• Pueblo Pintado Clinic

  • Clinic/Center
  • Cuba, NM
  • NPI 1023051133
  NPD
• Thoreau Clinic

  • Clinic/Center
  • Thoreau, NM
  • NPI 1679516702
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Presbyterian Healthcare Services

  dba Presbyterian Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470
  Care Compare affiliation
• Presbyterian Healthcare Services

  dba Presbyterian Kaseman Psych Unit

  • Psychiatric Hospital Unit
  • Albuquerque, NM
  • NPI 1598740482
  Care Compare affiliation

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

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1518247758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044232",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 N Main St",
            "address_purpose": "LOCATION",
            "city": "Kanab",
            "state": "UT",
            "postal_code": "847413260",
            "country_code": "US",
            "telephone_number": "435-644-4100",
            "fax_number": "435-644-3366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2450 S Telshor Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880115069",
            "country_code": "US",
            "telephone_number": "575-532-5455 x12",
            "fax_number": "575-532-5641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADER",
        "first_name": "PENNY",
        "middle_name": "J",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-19",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "13327156-4405",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-01828",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48922218",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1055 N 500 W",
            "address_2": "Attn Credentialing",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "84604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charis M Mackey
• Sondra June Macnaughtan, MSW LCSW
• Dawn Madden
• Megan Maddox
• Jared Madeo, NP
• Lynette Madill, RN
• Kortney Mae Madrigal, RN
• Erika Jackson Madsen
• Mathew Dell Madsen Jr., LCSW
• Taylor Madsen, LMFT

• Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.