Individual provider Active NPI

Amanda Campbell, PA-C

  • Physician Assistant
  • Merritt Island, FL
National Provider Identifier
1023570801
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113985 Issued in FL
Practice address
500 Crockett Blvd
Merritt Island, FL 32953-5034
Phone
(872) 231-3162
NPI assigned
Apr 2, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9113985 FL Primary

Addresses

Primary practice location

500 Crockett Blvd
Merritt Island, FL 32953-5034

Mailing address

PO Box 22239
New York, NY 10087-0001
Phone (702) 899-0595

Other practice location 1

587 Barton Blvd
Rockledge, FL 32955-3145
Phone (872) 231-3162

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230506000343 FL Practitioner - Physician Assistant 1951791805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.66 of 100Reported as group
Quality
73.72
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1023570801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22239",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100870001",
            "telephone_number": "702-899-0595",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CROCKETT BLVD",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329535034",
            "telephone_number": "872-231-3162"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "587 Barton Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockledge",
            "state": "FL",
            "postal_code": "329553145",
            "country_code": "US",
            "telephone_number": "872-231-3162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

Verify at the official NPI Registry.