Provider Demographics
| NPI: | 1083631071 |
|---|---|
| Name: | MAGELLA MEDICAL ASSOCIATES BILLING, INC. |
| Entity type: | Organization |
| Organization Name: | MAGELLA MEDICAL ASSOCIATES BILLING, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| 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 - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 972-437-5099 |
| Mailing Address - Street 1: | 1301 CONCORD TER |
| Mailing Address - Street 2: | |
| 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: | 2400 ROUND ROCK AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | ROUND ROCK |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78681-4004 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 512-341-1000 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | PEDIATRIX MEDICAL SERVICES |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-16 |
| Last Update Date: | 2025-04-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
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 | 2084A2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurocritical Care | 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 | 0001JV | Other | BCBS AUSTIN |
| TX | 0806424-02 | Medicaid | |
| TX | 125998834 | Medicaid | |
| TX | 1577629-01 | Medicaid | |
| TX | 8549305 | Other | AETNA GROUP |
| TX | 0004DJ | Other | BCBS AUSTIN |
| TX | 0022EZ | Other | BCBS DALLAS MFM |
| TX | 003DJ | Other | BCBS SA |
| TX | 5108785 | Other | AETNA AUSTIN/SA GROUP # |
| TX | 081018601 | Medicaid | |
| TX | 081018602 | Medicaid | |
| TX | 1518920-01 | Medicaid | |
| TX | 0096MW | Other | BCBS CARDI |
| TX | 00R87Z | Other | BCBS AUSTIN/SA CARDI GROUP |
| TX | 125998839 | Medicaid | |
| TX | 0806457-01 | Medicaid | |
| TX | 112890201 | Medicaid | |
| TX | 1577256-01 | Medicaid | |
| TX | 2151688 | Other | AETNA GROUP SA |
| TX | 0098JQ | Other | BCBS SA |
| TX | 0099JQ | Other | BCBS DALLAS |
| TX | 125998804 | Medicaid | |
| TX | 173248901 | Medicaid | |
| TX | 0806457-01 | Medicaid | |
| TX | 125998839 | Medicaid | |
| TX | 0004DJ | Other | BCBS AUSTIN |
| TX | 1518920-01 | Medicaid |
