Individual provider Active NPI

Amanda Brooke Wendenburg, FNP-BC

  • Nurse Practitioner
  • Raeford, NC
National Provider Identifier
1063083566
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
012345 Issued in NC
Practice address
6322 Fayetteville Rd
Raeford, NC 28376-7979
Phone
(910) 878-6700
NPI assigned
Jul 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 012345 NC
Nurse Practitioner 363L00000X 012345 NC Primary

Addresses

Primary practice location

6322 Fayetteville Rd
Raeford, NC 28376-7979

Mailing address

6322 Fayetteville Rd
Raeford, NC 28376-7979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210929003095 NC Practitioner - Nurse Practitioner 8224435524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCPC-16 LLCGroup PAC ID 4082841465, 6 clinicians

Practice addresses (Care Compare)

6322 Fayetteville Rd
Raeford, NC 28376-7979
Phone (910) 878-6700

Hospital & facility affiliations

  • Liberty Home Care, LLC Home health agency, Fayetteville, NC, CCN 347249
  • Firsthealth Moore Regional Hospital Hospital, Pinehurst, NC, CCN 340115

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as group
Quality
100
Promoting interoperability
91
Improvement activities
40
Cost
83.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
012345NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCPC-16, LLC Family Medicine CurrentSince Sep 7, 2021 Accepting new patients

Locations

46 Memorial Dr
Pinehurst, NC 28374
Phone (910) 295-6782

6322 Fayetteville Rd
Raeford, NC 28376
Phone (910) 878-6700

Interoperability endpoints

  • Direct secure messaging: awendenburg8378@firsthealth.direct-ci.net

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.

Hospital & facility affiliations 5

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": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1063083566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6322 FAYETTEVILLE RD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283767979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6322 FAYETTEVILLE RD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283767979",
            "telephone_number": "910-878-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDENBURG",
        "first_name": "AMANDA",
        "middle_name": "BROOKE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "012345",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "012345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raeford, NC

Sources for this page

Verify at the official NPI Registry.