NPIMap

Individual provider Active NPI

Amanda Lee Taglioli, PA-C

  • Medical Physician Assistant
  • Custer, SD
National Provider Identifier
1073794269
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0513 Issued in SD
Practice address
1041 Montgomery Street
Custer, SD 57730-1304
Phone
(605) 673-4150
Fax
(605) 673-3917
NPI assigned
Nov 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0513 SD Primary

Addresses

Primary practice location

1041 Montgomery Street
Custer, SD 57730-1304

Mailing address

317 Apple Dr
Steamboat Springs, CO 80487-3074
Phone (970) 461-6140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, WY2 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
I20100330000353 SD Practitioner - Physician Assistant 9133298243 Reassigns benefits to 1 organization
I20160121002369 WY Practitioner - Physician Assistant 9133298243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, 163 clinicians

Practice addresses (Care Compare)

1440 N Main St
Spearfish, SD 57783-1505
Phone (605) 644-4000

2200 13TH Ave
Belle Fourche, SD 57717-2215
Phone (605) 723-8970

930 N 10TH St
Spearfish, SD 57783-2202
Phone (605) 644-4335

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2391COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Oct 21, 2022 Accepting new patients
Monument Health Network, Inc. CurrentSince Oct 21, 2022 Accepting new patients
Big Thompson Medical Group Inc Past Accepting new patients

Locations

1041 Montgomery St
Custer, SD 57730
Phone (605) 662-7250

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

Organizations & group practices 4

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 9

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": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442966400000",
    "number": "1073794269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 APPLE DR",
            "city": "STEAMBOAT SPRINGS",
            "state": "CO",
            "postal_code": "804873074",
            "telephone_number": "970-461-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 MONTGOMERY STREET",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301304",
            "telephone_number": "605-673-4150",
            "fax_number": "605-673-3917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGLIOLI",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2015-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "0513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Custer, SD

Sources for this page

Verify at the official NPI Registry.