MAGELLA MEDICAL ASSOCIATES BILLING, INC.

Provider Demographics

• NPI: 1083631071
• Name: MAGELLA MEDICAL ASSOCIATES BILLING, INC.
• Entity Type: Organization
• Organization Name: MAGELLA MEDICAL ASSOCIATES BILLING, INC.
• Other - Org Name: MAGELLA MEDICAL ASSOCIATES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: ASSISTANT SECRETARY
• Authorized Official - Prefix: DR
• Authorized Official - First Name: MICHAEL
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: DWYER
• Authorized Official - Phone: 972-437-5099
• Mailing Address - Street 1: 1301 CONCORD TER
• Mailing Address - City: SUNRISE
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33323-2843
• Mailing Address - Country: US
• Mailing Address - Phone: 800-243-3829
• Mailing Address - Fax: 214-343-2814
• Practice Address - Street 1: 3001 E PRESIDENT GEORGE BUSH HWY
• Practice Address - Street 2: SUITE 250
• Practice Address - City: RICHARDSON
• Practice Address - State: TX
• Practice Address - Zip Code: 75082-3542
• Practice Address - Country: US
• Practice Address - Phone: 972-437-5099
• Practice Address - Fax: 214-343-2814
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: PEDIATRIX MEDICAL SERVICES
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-07-16
• Last Update Date: 2021-07-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2080N0001X	Allopathic & Osteopathic Physicians	Pediatrics	Neonatal-Perinatal Medicine	Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	2080P0008X	Allopathic & Osteopathic Physicians	Pediatrics	Neurodevelopmental Disabilities	Group - Multi-Specialty
No	2080P0202X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Cardiology	Group - Multi-Specialty
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	363LN0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Neonatal	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	0004DJ	Other	BCBS AUSTIN
TX	0096MW	Other	BCBS CARDI
TX	0098JQ	Other	BCBS SA
TX	125998804	Medicaid
TX	2151688	Other	AETNA GROUP SA
TX	003DJ	Other	BCBS SA
TX	125998839	Medicaid
TX	1518920-01	Medicaid
TX	1577629-01	Medicaid
TX	5108785	Other	AETNA AUSTIN/SA GROUP #
TX	081018601	Medicaid
TX	081018602	Medicaid
TX	0806424-02	Medicaid
TX	173248901	Medicaid
TX	0001JV	Other	BCBS AUSTIN
TX	0022EZ	Other	BCBS DALLAS MFM
TX	125998834	Medicaid
TX	00R87Z	Other	BCBS AUSTIN/SA CARDI GROUP
TX	0806457-01	Medicaid
TX	112890201	Medicaid
TX	0099JQ	Other	BCBS DALLAS
TX	1577256-01	Medicaid
TX	8549305	Other	AETNA GROUP
TX	0806457-01	Medicaid
TX	125998839	Medicaid
TX	0004DJ	Other	BCBS AUSTIN
TX	1518920-01	Medicaid