Mandie L Maddox, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28185360A Issued in IN

Practice address

2855 Miller Dr Ste 205
Plymouth, IN 46563-8093

Phone

(574) 941-1080

NPI assigned

May 25, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holm Medical Clinic IncGroup PAC ID 8022405208, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Holm Medical Clinic Inc

  • Family Medicine Physician
  • Plymouth, IN
  • NPI 1427799535
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • General Acute Care Hospital
  • Plymouth, IN
  • NPI 1174571129
  Care Compare affiliation

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

{
    "created_epoch": "1716595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1861232142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16597 18B RD",
            "city": "CULVER",
            "state": "IN",
            "postal_code": "465119733",
            "telephone_number": "574-339-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 MILLER DR STE 205",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465638093",
            "telephone_number": "574-941-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "MANDIE",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-25",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28185360A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis Plumlee DDS
• Lynn Ann Lucas, LCSW
• Kristine Luna, MA
• Michelle Lyle, RPH
• Lynn Lucas Counseling, LLC
• Molly Malone
• Susan Beth Mann, COTA
• Tracy Manns
• Amanda June Markand, NP
• Chavonda Marshall - Jackson, ED.D., LMHC

• Family Nurse Practitioner in Plymouth, IN
• Providers in Plymouth, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.