Individual provider Active NPI

Mary Alana Elmquist, GNP

  • Gerontology Nurse Practitioner
  • Amarillo, TX
National Provider Identifier
1770766453
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AP126334 Issued in TX
Practice address
6700 W 9TH Ave
Amarillo, TX 79106-1701
Phone
(806) 358-0200
Fax
(806) 356-5590
NPI assigned
Dec 17, 2007
Last updated
Nov 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP126334 TX Primary

Addresses

Primary practice location

6700 W 9TH Ave
Amarillo, TX 79106-1701

Mailing address

PO Box 840020
Dallas, TX 75284-0020
Phone (806) 358-0200

Other identifiers 2

IdentifierTypeStateIssuer
345016502MedicaidTX
881963OtherTXMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150130001528 TX Practitioner - Nurse Practitioner 5395820906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bsa Amarillo Diagnostic Clinic IncGroup PAC ID 5294959433, 31 clinicians

Practice addresses (Care Compare)

6700 SW 9TH Ave
Amarillo, TX 79106-1701
Phone (806) 358-0200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Colorado, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: maryelmquist@adcpa.allscriptsdirect.net
  • Direct secure messaging: mlink22900@ahs.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1770766453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840020",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840020",
            "telephone_number": "806-358-0200",
            "fax_number": "806-356-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 W 9TH AVE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061701",
            "telephone_number": "806-358-0200",
            "fax_number": "806-356-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMQUIST",
        "first_name": "MARY",
        "middle_name": "ALANA",
        "credential": "GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-17",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP126334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345016502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "881963",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.