Individual provider Active NPI

Amy Lynn Wadsworth, FNP

  • Family Nurse Practitioner
  • Brooklyn, MI
National Provider Identifier
1063013837
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704307540 Issued in MI
Practice address
212 S Main St Ste a
Brooklyn, MI 49230-9114
Phone
(517) 938-6085
Fax
(517) 938-6086
NPI assigned
Nov 6, 2020
Last updated
Feb 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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 4704307540 MI Primary

Addresses

Primary practice location

212 S Main St Ste a
Brooklyn, MI 49230-9114

Mailing address

24 Frank Lloyd Wright Dr # J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other practice location 1

45300 Cherry Hill Rd # 8190
Canton, MI 48187-5073
Phone (734) 981-3968

Other identifiers 1

IdentifierTypeStateIssuer
4704307540OtherMIMI LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20210909000439 MI Practitioner - Nurse Practitioner 8729484233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Michigan Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

1255 E M
Pinckney, MI 48169-8133
Phone (734) 878-1000

128 Van Buren St
Chelsea, MI 48118-1623
Phone (734) 475-8677

14288 E Old US Hwy 12
Chelsea, MI 48118-2700

202 W Highland Rd
Howell, MI 48843-1162

212 S Main St
Brooklyn, MI 49230-9114

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

5505 S Old US
Brighton, MI 48116-7524

5505 S Old US 23
101 Thimg Lifestyle Medicine Primary Care E
Brighton, MI 48116-7524
Phone (734) 887-7888

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Apr 1, 2024 Accepting new patients
Iha Health Services Corporation CurrentSince Apr 1, 2024 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

212 S Main St
Ste A
Brooklyn, MI 49230
Phone (517) 592-8033

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

1255 E M 36
Pinckney, MI 48169
Phone (734) 878-1000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

Interoperability endpoints

  • Direct secure messaging: awadsworth3204025@direct.trinity-health.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1604620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1063013837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR # J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S MAIN ST STE A",
            "city": "BROOKLYN",
            "state": "MI",
            "postal_code": "492309114",
            "telephone_number": "517-938-6085",
            "fax_number": "517-938-6086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45300 Cherry Hill Rd # 8190",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481875073",
            "country_code": "US",
            "telephone_number": "734-981-3968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-06",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704307540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "4704307540",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, MI

Sources for this page

Verify at the official NPI Registry.