Madison Fagerlie

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

012634 Issued in AZ

Practice address

24998 N 74TH Ave
Peoria, AZ 85383-6325

Phone

(623) 853-3428

NPI assigned

Apr 11, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1639922370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24998 N 74TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853836325",
            "telephone_number": "623-853-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24998 N 74TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853836325",
            "telephone_number": "623-853-3428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGERLIE",
        "first_name": "MADISON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-11",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "012634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Extended Care Portfolio Multistate Pool Tenant, LLC
• Eye See You Now
• Eye Studio Peoria LLC
• Preston Eyerman, PMHNP-BC
• Eyes Ears & Vitality LLC
• Shawn Fairchild
• Malvina Faja, PHARMD
• Vivian Fajardo, LCSW
• Charles Edward Falk, D.D.S.
• Family First Nemt LLC

• Emergency Medicine Physician in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Emergency Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.