Madeline Rose Mastectomy Boutique, LLC
NPI 1316693765 · Durable Medical Equipment & Medical Supplies · Vestal, NY
Enrolled with Medicare as Dme Supplier - Medical Supply Company · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Madeline Rose Mastectomy Boutique, LLC is a Durable Medical Equipment & Medical Supplies organization in Vestal, NY (NPI 1316693765).
Provider details
- NPI number
- 1316693765
- Entity type
- Organization
- Primary specialty
- Durable Medical Equipment & Medical SuppliesSuppliers
- Organization subpart
- No
- Authorized official
- Jamie Walck, Owner(607) 296-2021
Specialties & taxonomies
Suppliers
- Mastectomy Fitter224900000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2022-02-24
- Last updated
- 2022-07-26
- Certified
- 2022-05-31
Frequently asked questions
- What is Madeline Rose Mastectomy Boutique, LLC's NPI number?
- Madeline Rose Mastectomy Boutique, LLC's National Provider Identifier (NPI) is 1316693765, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Madeline Rose Mastectomy Boutique, LLC?
- Madeline Rose Mastectomy Boutique, LLC is classified in the NPPES registry as Durable Medical Equipment & Medical Supplies (Suppliers).
- Where is Madeline Rose Mastectomy Boutique, LLC located?
- Madeline Rose Mastectomy Boutique, LLC's practice location on file with NPPES is 100 Rano Blvd, Vestal, NY 13850-2776.
- What is Madeline Rose Mastectomy Boutique, LLC's phone number?
- The practice phone number listed in the NPPES registry for Madeline Rose Mastectomy Boutique, LLC is (607) 296-2021.
- Does Madeline Rose Mastectomy Boutique, LLC accept Medicare?
- Madeline Rose Mastectomy Boutique, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Madeline Rose Mastectomy Boutique, LLC?
- The authorized official listed on Madeline Rose Mastectomy Boutique, LLC's NPPES record is Jamie Walck, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Madeline Rose Mastectomy Boutique, LLC's NPI active?
- Yes — Madeline Rose Mastectomy Boutique, LLC's NPI (1316693765) is active in the NPPES registry as of the last update on 2022-07-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.