NPIMap

Individual provider Active NPI

Amy Jo Miltenberger, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1093852139
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12161 Issued in NC
Practice address
2801 Randolph Rd Ste 100
Charlotte, NC 28211-1051
Phone
(704) 367-4800
Fax
(704) 316-3025
NPI assigned
Jan 30, 2007
Last updated
Aug 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 0010-12161 NC Primary

Addresses

Primary practice location

2801 Randolph Rd Ste 100
Charlotte, NC 28211-1051

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

6567 E Carondelet Dr
305
Tucson, AZ 85710-6152
Phone (520) 881-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, NC2 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
I20080124000504 AZ Practitioner - Physician Assistant 8426130873 Reassigns benefits to 1 organization
I20220902001361 NC Practitioner - Physician Assistant 8426130873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Cora South Carolina LLCGroup PAC ID 3173766334, shared by 6 NPIs, 220 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 343-9800

2801 Randolph Rd
Charlotte, NC 28211-1051

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

330 Billingsley Rd
Charlotte, NC 28211-5020

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

7825 Ballantyne Commons Pkwy
Suite 150
Charlotte, NC 28277-3175
Phone (704) 316-3070

9787 Charlotte Hwy
Fort Mill, SC 29707-8103
Phone (839) 293-0007

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Sep 6, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Sep 6, 2022 Accepting new patients
Pusch Ridge Family Medicine, PLLC Past Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

2801 Randolph Rd
Ste 100
Charlotte, NC 28211
Phone (704) 367-4800

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: amiltenberger1069476@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1093852139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 RANDOLPH RD STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111051",
            "telephone_number": "704-367-4800",
            "fax_number": "704-316-3025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6567 E Carondelet Dr",
            "address_2": "305",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857106152",
            "country_code": "US",
            "telephone_number": "520-881-8400",
            "fax_number": "520-881-6563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILTENBERGER",
        "first_name": "AMY",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.