Amanda Takke, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62025 Issued in CA

Practice address

1524 McHenry Ave Ste 135
Modesto, CA 95350-4569

Phone

(209) 575-5801

Fax

(209) 575-0115

NPI assigned

Aug 2, 2022

Last updated

Mar 19, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Amanda Jacobsen Former name

Medicare fee-for-service enrollment

Enrolled in CA, UT2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

96.69 of 100Reported as group

Quality

90

Improvement activities

40

Cost

78.43

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Davis, CA
  • NPI 1326346438
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Los Alamitos, CA
  • NPI 1497430870
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1073240925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 MCHENRY AVE STE 135",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504569",
            "telephone_number": "209-575-5801",
            "fax_number": "209-575-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 MCHENRY AVE STE 135",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504569",
            "telephone_number": "209-575-5801",
            "fax_number": "209-575-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKKE",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13136356-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62025",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JACOBSEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul Keng Taing
• Patricia Tajii
• Joan Tajon
• Takeflighttransportation
• Glenn A. Takenaga, DDS, BS
• La Tanya Alicia Takla, EDD, LMFT, LPCC
• Virginia Tifuh Taku, NP
• Evangelina A Talaro
• Benjamin Martin Talbott
• Rebecca Caroline Taliaferro

• Physician Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.