Individual provider Active NPI

Megan Jean Madole, NP

  • Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1639609407
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704288386 Issued in MI
Practice address
1000 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-3680
Phone
(616) 459-3158
Fax
(616) 742-6758
NPI assigned
Jun 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704288386 MI Primary

Addresses

Primary practice location

1000 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-3680

Mailing address

1000 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-3680
Phone (616) 459-3158

Other practice location 1

4069 Lake Dr SE Ste 315
Grand Rapids, MI 49546-8816
Phone (616) 267-7700

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170823000434 MI Practitioner - Nurse Practitioner 9537431796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Valley Medical Specialists PLCGroup PAC ID 1254311947, 19 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

1000 E Paris Ave SE
Suite 100
Grand Rapids, MI 49546-3680
Phone (616) 459-3158

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Valley Medical Specialists PLC CurrentSince Jan 9, 2023 Accepting new patients

Locations

1000 East Paris Ave SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 459-3158

2093 Health Dr SW
Ste 200
Wyoming, MI 49519
Phone (616) 459-3158

Organizations & group practices 2

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.

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": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1639609407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463680",
            "telephone_number": "616-459-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463680",
            "telephone_number": "616-459-3158",
            "fax_number": "616-742-6758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4069 Lake Dr SE Ste 315",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495468816",
            "country_code": "US",
            "telephone_number": "616-267-7700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADOLE",
        "first_name": "MEGAN",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704288386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.