MRS. AMY MICHELLE MEDALIE NP
NPI 1003045204
Nurse Practitioner - Pediatrics in Fort Worth, TX
About Mrs. Amy Michelle Medalie Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. AMY MICHELLE MEDALIE NP (NPI 1003045204) is an individual pediatrics provider in Fort Worth, Texas, licensed in Colorado (6037) and active in the NPI registry since July 2009. She is enrolled in Medicare PECOS and maintains a secondary practice location in Lakewood.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Amy Michelle Medalie Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Amy Medalie reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fort Worth, TX 76104
- Reassigned Medicare billing, Texas enrollment
- Medicare enrollment name: Cook Childrens Physician Network
- 1,186 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 76114 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FT WORTH, TX 76114
FORT WORTH, TX 76114
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Amy Medalie's NPI number?
The NPI number for Amy Medalie is 1003045204. It was assigned to this individual provider in the NPPES registry on July 8, 2009. The provider is also known as Amy Michelle Medalie Rn.
Where is Amy Medalie located?
Amy Medalie practices at 4405 River Oaks Blvd, Fort Worth, TX 76114. The listed phone number is (817) 624-1770.
What is Amy Medalie's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Amy Medalie enrolled in Medicare?
Yes. Amy Medalie is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Amy Medalie's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Amy Medalie reassigns Medicare benefits to Cook Children's Physician Network (Fort Worth, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Amy Medalie's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Amy Medalie accept?
Health plans from Imperial Insurance Companies, Inc. list Amy Medalie as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Amy Medalie was last updated on April 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mrs. Amy Michelle Medalie, NP · NPI 1003045204
Pediatrics physician in Fort Worth, Texas. Individual provider, active in the CMS NPPES registry since July 8, 2009.
## Identity
- **NPI:** 1003045204 (Entity type: Individual)
- **Enumerated:** July 8, 2009
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 6037 (Colorado)
- **Sole proprietor:** No
## Practice location
- **Address:** 4405 RIVER OAKS BLVD, Fort Worth, TX 76114-2326
- **Phone:** (817) 624-1770 · **Fax:** (817) 625-1287
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Cook Children's Physician Network (NPI 1548230923, Fort Worth, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 7, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1003045204) · Data from the CMS NPPES public registry.