Individual provider Active NPI

Amanda NG

  • Physician Assistant
  • Beverly Hills, CA
National Provider Identifier
1043944143
Registry record updated Nov 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
9150 Wilshire Blvd Ste 205
Beverly Hills, CA 90212-3429
Phone
(805) 222-5803
NPI assigned
Jul 13, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2024

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 Primary

Addresses

Primary practice location

9150 Wilshire Blvd Ste 205
Beverly Hills, CA 90212-3429

Mailing address

9150 Wilshire Blvd Ste 205
Beverly Hills, CA 90212-3429
Phone (781) 985-9553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20250107003871 CA Practitioner - Physician Assistant 5294263018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Dermatology Institute PCGroup PAC ID 6800177460, 25 clinicians

Practice addresses (Care Compare)

3095 Old Conejo Rd
Suite 200
Thousand Oaks, CA 91320-2130
Phone (888) 367-1850

5725 Soto St
Huntington Park, CA 90255-2630
Phone (888) 367-1850

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62915CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
California Rheumatology Institute Inc Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732838400000",
    "number": "1043944143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9150 WILSHIRE BLVD STE 205",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902123429",
            "telephone_number": "781-985-9553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9150 WILSHIRE BLVD STE 205",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902123429",
            "telephone_number": "805-222-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NG",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.