Organization Active NPI

M Angela Madden LLC

  • Internal Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1548515968
Registry record updated Aug 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME79511 Issued in FL
Legal business name
M ANGELA MADDEN LLC
Practice address
1130 Bayview Dr
Fort Lauderdale, FL 33304-2505
Phone
(954) 563-3158
Fax
(954) 563-5874
NPI assigned
Jul 23, 2012
Last updated
Aug 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2012

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

Authorized official

Name
Dr. Mary A Madden, MD
Title
Doctor
Phone
(954) 563-3158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME79511 FL Primary

Addresses

Primary practice location

1130 Bayview Dr
Fort Lauderdale, FL 33304-2505

Mailing address

1130 Bayview Dr
Fort Lauderdale, FL 33304-2505
Phone (954) 563-3158

Other identifiers 5

IdentifierTypeStateIssuer
0463133OtherFLAETNA
F00219567801OtherNEIGHBORHOOD HEALTH
0001185OtherFLAARP MEDICARE COMPLETE
51661OtherFLMEDICARE
CK2070OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120822000226 FL Part B Supplier - Clinic/Group Practice 7517114879 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Locations

1130 Bayview Dr
Ft Lauderdale, FL 33304
Phone (954) 563-3158

1700 NE 26th St
Wilton Manors, FL 33305
Phone (954) 563-5861

1700 NE 26th St
Ste 4
Wilton Manors, FL 33305
Phone (954) 563-3158

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17224/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1548515968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 BAYVIEW DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333042505",
            "telephone_number": "954-563-3158",
            "fax_number": "954-563-5874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 BAYVIEW DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333042505",
            "telephone_number": "954-563-3158",
            "fax_number": "954-563-5874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M ANGELA MADDEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-23",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "MADDEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "954-563-3158",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME79511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0463133",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH",
            "identifier": "F00219567801",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AARP MEDICARE COMPLETE",
            "identifier": "0001185",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "51661",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK2070",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.