Individual provider Active NPI

Amanda Peters

  • Family Nurse Practitioner
  • Jefferson City, MO
National Provider Identifier
1093265266
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2016036095 Issued in MO
Practice address
1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone
(573) 635-5264
NPI assigned
Oct 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2016036095 MO Primary

Addresses

Primary practice location

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

Mailing address

1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone (573) 635-5264

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20161117000924 MO Practitioner - Nurse Practitioner 7315226230 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson City Medical Group PCGroup PAC ID 1850371089, shared by 7 NPIs, 117 clinicians

Practice addresses (Care Compare)

1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone (573) 556-5771

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson City Medical Group, P.C. CurrentSince Dec 1, 2016 Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
Jefferson City Medical Group, P.C. CurrentSince Dec 1, 2016 Accepting new patients
Jefferson City Medical Group, P.C. Past Accepting new patients

Locations

1241 W Stadium Blvd
#L400B
Jefferson Cty, MO 65109
Phone (573) 556-7724

1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771

Interoperability endpoints

  • Direct secure messaging: amanda.peters@jcmg.eclinicaldirectplus.com

Organizations & group practices 6

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": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1093265266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-635-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-635-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2016036095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.