Individual provider Active NPI

Amanda Catherine Maderia, DNP, FNP-C

  • Nurse Practitioner
  • Kernersville, NC
National Provider Identifier
1063197408
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5018473 Issued in NC
Practice address
111 Gateway Center Dr
Kernersville, NC 27284-2999
Phone
(336) 713-5116
NPI assigned
Jun 21, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 271039 NC
Nurse Practitioner 363L00000X 5018473 NC Primary

Addresses

Primary practice location

111 Gateway Center Dr
Kernersville, NC 27284-2999

Mailing address

5715 Misty Hill Cir
Clemmons, NC 27012-9670
Phone (364) 731-3743

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
I20230905000225 NC Practitioner - Nurse Practitioner 5890158141 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
271039NCMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Yadkin Emergency Physicians, PLLC CurrentSince Jul 17, 2023 Accepting new patients
Tanglewood Park Physicians, PLLC CurrentSince Jul 17, 2023 Accepting new patients
Wake Forest University Health Sciences CurrentSince Apr 1, 2024 Accepting new patients
Kernersville Emergency Group, PLLC CurrentSince Jul 17, 2023 Accepting new patients
Piedmont Triad Physicians, PLLC CurrentSince Jul 17, 2023 Accepting new patients

Locations

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

180 Parkwood Dr
Elkin, NC 28621
Phone (336) 527-7000

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

111 Gateway Center Dr
Kernersville, NC 27284
Phone (336) 996-2173

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: amaderia2883187@carolinashealthcaresystem.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1063197408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 MISTY HILL CIR",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129670",
            "telephone_number": "364-731-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GATEWAY CENTER DR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842999",
            "telephone_number": "336-713-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADERIA",
        "first_name": "AMANDA",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-21",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "271039",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5018473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.