NPIMap

Individual provider Active NPI

Amanda Lynn Oeder, PA

  • Physician Assistant
  • Waukesha, WI
National Provider Identifier
1053936088
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5504 Issued in WI
Practice address
N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone
(262) 696-0909
NPI assigned
Jun 16, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5504 WI Primary
Physician Assistant 363A00000X PA.0009263 CO
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

N16W24131 Riverwood Dr
Waukesha, WI 53188-1106

Mailing address

1902 E Broadway Apt 420
Waukesha, WI 53186-8183
Phone (920) 492-9201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211025000011 WI Practitioner - Physician Assistant 4183012149 Reassigns benefits to 1 organization
I20250926002323 CO Practitioner - Physician Assistant 4183012149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Oct 27, 2025 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Physician Assistant CurrentSince Oct 18, 2021 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Oct 27, 2025 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

19333 W North Ave
Brookfield, WI 53045
Phone (262) 785-2000

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1053936088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 E BROADWAY APT 420",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531868183",
            "telephone_number": "920-492-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N16W24131 RIVERWOOD DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881106",
            "telephone_number": "262-696-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OEDER",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5504",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009263",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.