Madelyn M Nickerson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9109804 Issued in FL

Practice address

6801 4TH St N
St Petersburg, FL 33702-6844

Phone

(727) 822-3238

Fax

(727) 823-1278

NPI assigned

Oct 23, 2016

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

Other names 1

• Ms. Madelyn McNamara Screnock Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baycare Home Care Inc Home health agency, Largo, FL, CCN 107212
• St Josephs Hospital Hospital, Tampa, FL, CCN 100075
• St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067
• Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baycare Medical Group, Inc.

  • General Practice Physician
  • Clearwater, FL
  • NPI 1043269871

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Baycare Medical Group, Inc.

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1659720837
  NPD

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

• Baycare Home Care, Inc.

  • Home Health Agency
  • Largo, FL
  • NPI 1033117007
  Care Compare affiliation
• Morton Plant Hospital Association Inc

  dba Morton Plant Hospital

  • General Acute Care Hospital
  • Clearwater, FL
  • NPI 1376529743
  Care Compare affiliation
• St. Anthonys Hospital, Inc.

  dba St. Anthonys Hospital

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1427024942
  Care Compare affiliation
• St. Joseph's Hospital, Inc.

  dba St. Joseph's Women's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1346519816
  Care Compare affiliation
• St. Joseph's Hospital, Inc.

  dba St. Joseph's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1881632818
  Care Compare affiliation

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

{
    "created_epoch": "1477180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1609327816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337026844",
            "telephone_number": "727-822-3238",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337026844",
            "telephone_number": "727-822-3238",
            "fax_number": "727-823-1278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "MADELYN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-23",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9109804",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109804",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019646400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "madelyn.screnock@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Medical Group, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew Street",
            "address_2": "East Bldg 2nd Floor",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MADELYN",
            "last_name": "SCRENOCK",
            "middle_name": "MCNAMARA",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cynthia D Nicholas, CRNA
• Shelley Nicholls, APRN
• Lisa Kay Nichols, R.N.
• Karen Christine Nicholson, P.T.A.
• Noura Nickel, M.D.
• Michael Scott Nickerson, MS, ARNP-C, COHN-S
• Nicole Agresto, Psychology P.a.
• Krissle Nicome, APRN
• Abigail Grace Niebrugge, BCABA
• Michael Louis Nieder, M.D.

• Medical Physician Assistant in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.