NPIMap

Individual provider Active NPI

Amanda Marie Stevens, PA-C

  • Physician Assistant
  • Altus, OK
National Provider Identifier
1083854939
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2651 Issued in OK
Practice address
304 S Park LN
Altus, OK 73521-5753
Phone
(580) 379-6500
Fax
(580) 379-6509
NPI assigned
Mar 4, 2009
Last updated
Nov 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2651 OK Primary

Addresses

Primary practice location

304 S Park LN
Altus, OK 73521-5753

Mailing address

304 S Park LN
Altus, OK 73521-5753
Phone (580) 379-6500

Other identifiers 1

IdentifierTypeStateIssuer
200656930AMedicaidOK

Other names 1

  • Amanda Marie Caldwell Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address AmandaCaldwell@direct.jcmh.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160913002690 OK Practitioner - Physician Assistant 3072662931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 E Pecan St
Altus, OK 73521-6141

205 S Park LN
Suite 210
Altus, OK 73521-5757
Phone (580) 379-6650

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2651OKMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority CurrentSince Aug 1, 2016 Accepting new patients
Mecosta County Medical Center Physician Assistant Past Accepting new patients
Jackson County Memorial Hosp Phcy Past Accepting new patients
Hawaii Neurosurgery Group LLP PastSince Apr 1, 2004 Accepting new patients

Locations

1200 E Pecan St
Altus, OK 73521
Phone (580) 379-5000

205 S Park Ln
Ste 210
Altus, OK 73521
Phone (580) 379-6650

304 S Park Ln
Altus, OK 73521
Phone (580) 379-6500

Interoperability endpoints

  • Direct secure messaging: amandacaldwell@direct.jcmh.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1236124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1083854939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215753",
            "telephone_number": "580-379-6500",
            "fax_number": "580-379-6509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215753",
            "telephone_number": "580-379-6500",
            "fax_number": "580-379-6509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-04",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200656930A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "AmandaCaldwell@direct.jcmh.com",
            "affiliation": "N",
            "address_1": "304 S Park Ln",
            "city": "Altus",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735215753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "CALDWELL",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Altus, OK

Sources for this page

Verify at the official NPI Registry.