Individual provider Active NPI

Madison Carol Brewer, FNP-C

  • Family Nurse Practitioner
  • Laurel, MS
National Provider Identifier
1679112304
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
903732 Issued in MS
Practice address
1203 Jefferson St
Laurel, MS 39440-4354
Phone
(601) 649-2863
Fax
(601) 649-7628
NPI assigned
Dec 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 903732 MS Primary

Addresses

Primary practice location

1203 Jefferson St
Laurel, MS 39440-4354

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 425-7550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20200324003922 MS Practitioner - Nurse Practitioner 5698103604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Central Clinics, IncGroup PAC ID 4385876655, 117 clinicians

Practice addresses (Care Compare)

1203 Ave B
Ellisville, MS 39437-2080
Phone (601) 477-2226

1220 Jefferson St
Laurel, MS 39440-4355
Phone (601) 399-6169

Hospital & facility affiliations

  • South Central Reg Med Ctr Hospital, Laurel, MS, CCN 250058

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Cinics, Inc CurrentSince Jul 25, 2024 Accepting new patients
South Central Clinics, Inc CurrentSince Jul 25, 2024 Accepting new patients
South Central Clinics, Inc Current Accepting new patients
South Central Clinics, Inc. Past Accepting new patients
Trustcare Primary Care, LLC Past Accepting new patients

Locations

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1203 Ave B
Ste 200
Ellisville, MS 39437
Phone (601) 477-3550

1203 Jefferson St
Laurel, MS 39440
Phone (601) 579-5488

Organizations & group practices 8

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 1

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": "1577491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1679112304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-425-7550",
            "fax_number": "601-649-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404354",
            "telephone_number": "601-649-2863",
            "fax_number": "601-649-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "MADISON",
        "middle_name": "CAROL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-28",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.