Individual provider Active NPI

Amanda Marie Painter, LCSW

  • Clinical Social Worker
  • Wellsville, UT
National Provider Identifier
1013265644
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8934266-3501 Issued in UT
Practice address
2180 S 1450 W
Wellsville, UT 84339-6733
Phone
(801) 695-5520
NPI assigned
Aug 29, 2012
Last updated
Nov 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 8934266-3501 UT
Addiction (Substance Use Disorder) Counselor 101YA0400X 8934266-3501 UT
Mental Health Counselor 101YM0800X 8934266-3501 UT
Social Worker 104100000X 8934266-3501 UT
Case Manager/Care Coordinator 171M00000X 8934266-3501 UT
Adult Companion 372600000X
Clinical Social Worker 1041C0700X 8934266-3501 UT Primary

Addresses

Primary practice location

2180 S 1450 W
Wellsville, UT 84339-6733

Mailing address

2180 S 1450 W
Wellsville, UT 84339-6733
Phone (801) 695-5520

Other names 1

  • Amanda Marie Takacs Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241226002707 NM Practitioner - Clinical Social Worker 5597292847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
McLeod Medical Centers of NM IncGroup PAC ID 5092075531, 54 clinicians

Practice addresses (Care Compare)

12127B N Hwy 14
Suite 5
Cedar Crest, NM 87008-9557
Phone (505) 281-5180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8934266-3501UTMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Medical Centers of NM, Inc. CurrentSince Dec 16, 2024 Accepting new patients
McLeod Medical Centers of NM, Inc. Current Accepting new patients

Locations

7200 Montgomery Blvd NE
Ste 7121
Albuquerque, NM 87109
Phone (408) 781-0505

12127 N State Highway 14
Ste 5
Cedar Crest, NM 87008
Phone (505) 281-2460

Interoperability endpoints

  • Direct secure messaging: amanda.painter.1@27050.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1013265644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 S 1450 W",
            "city": "WELLSVILLE",
            "state": "UT",
            "postal_code": "843396733",
            "telephone_number": "801-695-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 S 1450 W",
            "city": "WELLSVILLE",
            "state": "UT",
            "postal_code": "843396733",
            "telephone_number": "801-695-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINTER",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "UT",
            "license": "8934266-3501",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "8934266-3501",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8934266-3501",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "8934266-3501",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "UT",
            "license": "8934266-3501",
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8934266-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "TAKACS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wellsville, UT

Sources for this page

Verify at the official NPI Registry.