Individual provider Active NPI

Amanda Lane Lewis, FNP

  • Family Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1053726752
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP07873 Issued in LA
Practice address
2508 Bert Kouns Industrial Loop Ste 105
Shreveport, LA 71118-3175
Phone
(318) 797-2328
Fax
(318) 212-5674
NPI assigned
Jun 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP07873 LA Primary

Addresses

Primary practice location

2508 Bert Kouns Industrial Loop Ste 105
Shreveport, LA 71118-3175

Mailing address

2508 Bert Kouns Industrial Loop Ste 105
Shreveport, LA 71118-3175
Phone (318) 797-2328

Other identifiers 1

IdentifierTypeStateIssuer
2401521MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20150619002105 LA Practitioner - Nurse Practitioner 6406167204 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
WKMC Cardiovascular ConsultantsGroup PAC ID 0941420061, 34 clinicians

Practice addresses (Care Compare)

2727 Hearne Ave
Suite 301
Shreveport, LA 71103-3918
Phone (318) 631-6400

Hospital & facility affiliations

  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Merit-based Incentive Payment System (MIPS)

Final score
91.53 of 100Reported as apm
Quality
81.42
Promoting interoperability
94.6
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
WKMC Cardiovascular Consultants CurrentSince Feb 1, 2018 Accepting new patients
Advanced Cardiovascular Specialists PastSince Jul 1, 2017 Accepting new patients
North Louisiana Internal Medicine PastSince Mar 5, 2017 Accepting new patients

Locations

2400 Hospital Dr
Ste 350
Bossier City, LA 71111
Phone (318) 212-7902

2400 Hospital Dr
Ste 380
Bossier City, LA 71111
Phone (318) 747-7888

102 S Monroe St
Minden, LA 71055
Phone (318) 377-3425

1809 Northpointe Ln
Ste 130
Ruston, LA 71270

2600 Greenwood Rd
Shreveport, LA 71103
Phone (318) 212-4600

2508 Bert Kouns Industrial Loop
Ste 105
Shreveport, LA 71118
Phone (318) 688-1204

8001 Youree Dr
Ste 740
Shreveport, LA 71115
Phone (318) 212-3830

2727 Hearne Ave
Ste 215
Shreveport, LA 71103
Phone (318) 212-4791

2727 Hearne Ave
Ste 300
Shreveport, LA 71103
Phone (318) 798-9400

2727 Hearne Ave
Ste 301
Shreveport, LA 71103

10320 Little Patuxent Pkwy
Ste 23302
Columbia, MD 21044

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1053726752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183175",
            "telephone_number": "318-797-2328",
            "fax_number": "318-212-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183175",
            "telephone_number": "318-797-2328",
            "fax_number": "318-212-5674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "AMANDA",
        "middle_name": "LANE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2401521",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.