Individual provider Active NPI

Megan Louise Madore, NP

  • Nurse Practitioner
  • Flint, TX
National Provider Identifier
1891269403
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP140218 Issued in TX
Practice address
18118 FM 344 W
Flint, TX 75762-6010
Phone
(903) 825-3292
Fax
(903) 825-3151
NPI assigned
Jan 16, 2019
Last updated
Jan 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP140218 TX Primary

Addresses

Primary practice location

18118 FM 344 W
Flint, TX 75762-6010

Mailing address

PO Box 130549
Tyler, TX 75713-0549
Phone (903) 579-3931

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
I20190307000582 TX Practitioner - Nurse Practitioner 7517206675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Lake Medical, PLLCGroup PAC ID 2961885850, 4 clinicians

Practice addresses (Care Compare)

11980 State Hwy 64 E
Suite G
Tyler, TX 75707-2541
Phone (903) 650-8619

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP140218TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Jan 1, 2019 Accepting new patients
East Lake Medical, PLLC Nurse Practitioner CurrentSince Apr 5, 2024 Accepting new patients
Etmc Physician Group Inc. CurrentSince Jan 1, 2019 Accepting new patients
Starks Medical Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

11980 State Highway 64 E
Ste G
Tyler, TX 75707
Phone (903) 650-8619

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": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1891269403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130549",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757130549",
            "telephone_number": "903-579-3931",
            "fax_number": "903-509-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18118 FM 344 W",
            "city": "FLINT",
            "state": "TX",
            "postal_code": "757626010",
            "telephone_number": "903-825-3292",
            "fax_number": "903-825-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADORE",
        "first_name": "MEGAN",
        "middle_name": "LOUISE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP140218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, TX

Sources for this page

Verify at the official NPI Registry.