Individual provider Active NPI

Madison Elizabeth Freeman, PA-C

  • Physician Assistant
  • Longview, TX
National Provider Identifier
1821761008
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA14609 Issued in TX
Practice address
2010 Bill Owens Pkwy
Longview, TX 75604-6210
Phone
(903) 247-3400
NPI assigned
Jul 26, 2021
Last updated
Dec 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA14609 TX Primary

Addresses

Primary practice location

2010 Bill Owens Pkwy
Longview, TX 75604-6210

Mailing address

1100 McCann Road
Apartment H201
Longview, TX 75601

Other identifiers 3

IdentifierTypeStateIssuer
429962001MedicaidTX
8QD865OtherTXBCBS
1T5302OtherTXMEDICARE

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
I20210831000056 TX Practitioner - Physician Assistant 2163828179 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

301 Richland W Cir
Providence Internal Medicine Clinic
Waco, TX 76712-7932
Phone (254) 537-6200

340 Richland W Cir
Ascension Medical Group Providence
Waco, TX 76712-7919
Phone (254) 537-6050

342 Richland W Cir
Waco, TX 76712-7919
Phone (254) 537-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA14609TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Oct 11, 2021 Accepting new patients
Providence Health Alliance CurrentSince Dec 11, 2023 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Oct 11, 2021 Accepting new patients

Locations

2010 Bill Owens Pkwy
Longview, TX 75604
Phone (903) 247-3400

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

301 Richland West Cir
Waco, TX 76712
Phone (254) 537-6200

6101 Woodway Dr
Ste 200
Woodway, TX 76712
Phone (254) 537-6300

7003 Woodway Dr
Ste 311
Woodway, TX 76712
Phone (254) 537-6000

Interoperability endpoints

  • Direct secure messaging: madison.freeman.1@9635.direct.athenahealth.com
  • Direct secure messaging: mfreeman266330@christushealth.direct-ci.net

Organizations & group practices 4

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 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": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1821761008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MCCANN ROAD",
            "address_2": "APARTMENT H201",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 BILL OWENS PKWY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756046210",
            "telephone_number": "903-247-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "MADISON",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA14609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429962001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8QD865",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1T5302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.