Amanda Mendoza, PA
Individual provider Active NPI Physician Assistant · Grand Rapids, MI
NPI 1013620707 · NPPES record last updated Aug 12, 2024
Key facts
- NPI
- 1013620707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601011572 (MI)
- Practice address
- 100 Michigan St NE
Grand Rapids, MI 49503-2560 - Phone
- (616) 391-8640
- NPI assigned
- Dec 28, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- James E Dewitt DPM PC
Practice addresses (Care Compare)
1621 44TH St SW
Suite 500
Wyoming, MI 49509-7200
Phone (616) 538-4442
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230131001779 | MI | Practitioner - Physician Assistant | 2062883960 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601011572 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Foot and Ankle Associates, PC | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Physician Assistant | Current |
Accepting new patients |
Locations
10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850
300 Lafayette Ave SE
Ste 2045
Grand Rapids, MI 49503
Phone (616) 685-3098
1621 44th St SW
Ste 500
Wyoming, MI 49509
Phone (616) 538-4442
1621 44th St SW
Wyoming, MI 49509
Phone (616) 532-9003
Interoperability endpoints
- amendoza2491567@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601011572 | MI | Yes |
Addresses
Primary practice location
100 Michigan St NE
Grand Rapids, MI 49503-2560
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other providers in Grand Rapids, MI
- Amber Mena Mendiola-Suarez
- Alan Mendoza Arce
- Cinthia S Mendoza Medina
- Almadelia Mendoza-Brito
- Christian Dat Mendoza-Huynh
- Carina Miranda Mendoza
- Cora Menelli
- Heather Joy Menerey
- Noah Jason Menerey
- Travis Menge
All providers in Grand Rapids, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.