NPIMap

Individual provider Active NPI

Amanda C Fadenrecht, FNP-C

  • Primary Care Nurse Practitioner
  • Pueblo West, CO
National Provider Identifier
1023425386
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APN-0991259 Issued in CO
Practice address
141 S Purcell Blvd Ste 140
Pueblo West, CO 81007-5123
Phone
(719) 281-9587
Fax
(855) 593-6512
NPI assigned
Jul 18, 2014
Last updated
Feb 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN0991259NP CO
Primary Care Nurse Practitioner 363LP2300X APN-0991259 CO Primary

Addresses

Primary practice location

141 S Purcell Blvd Ste 140
Pueblo West, CO 81007-5123

Mailing address

141 S Purcell Blvd Ste 140
Pueblo West, CO 81007-5123
Phone (719) 281-9587

Other identifiers 1

IdentifierTypeStateIssuer
APN0991259NPOtherCOSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140930000996 CO Practitioner - Nurse Practitioner 9739309568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pueblo West Primary Care, LLCGroup PAC ID 5991138802, 2 clinicians

Practice addresses (Care Compare)

141 S Purcell Blvd
Suite 140
Pueblo West, CO 81007-5123
Phone (719) 281-9587

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN0991259NPCOMDFamily Nurse Practitioner
APN-0991259COMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo West Primary Care LLC CurrentSince Sep 8, 2019 Accepting new patients

Locations

141 S Purcell Blvd
Ste 140
Pueblo West, CO 81007
Phone (719) 281-9587

Interoperability endpoints

  • Direct secure messaging: amanda.fadenrecht.1@19630.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19630/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1023425386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 S PURCELL BLVD STE 140",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075123",
            "telephone_number": "719-281-9587",
            "fax_number": "855-593-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S PURCELL BLVD STE 140",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075123",
            "telephone_number": "719-281-9587",
            "fax_number": "855-593-6512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADENRECHT",
        "first_name": "AMANDA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2021-02-12",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN0991259NP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "APN-0991259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "APN0991259NP",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo West, CO

Sources for this page

Verify at the official NPI Registry.