Individual provider Active NPI

Amanda Marie Marquis, AU.D.

  • Audiologist
  • Philadelphia, PA
National Provider Identifier
1114175270
Registry record updated Nov 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AT006088 Issued in PA
Practice address
3900 Woodland Ave
Philadelphia, PA 19104-4551
Phone
(215) 823-5800
NPI assigned
Sep 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AT006088 PA Primary

Addresses

Primary practice location

3900 Woodland Ave
Philadelphia, PA 19104-4551

Mailing address

461 Ripka St
Philadelphia, PA 19128-3331
Phone (352) 246-6407

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131211000691 NH Practitioner - Qualified Audiologist 5991932345 Reassigns benefits to 1 organization
I20140714001457 MA Practitioner - Qualified Audiologist 5991932345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Massachusetts ENT Associates IncGroup PAC ID 6305891110, 20 clinicians

Practice addresses (Care Compare)

280 Main St
Suite 140
Nashua, NH 03060-2920
Phone (603) 594-3025

321 Billerica Rd
Suite 202
Chelmsford, MA 01824-4100
Phone (978) 256-5557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AT006088PAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts ENT Associates Inc CurrentSince Oct 1, 2013 Accepting new patients

Locations

321 Billerica Rd
Ste 202
Chelmsford, MA 01824
Phone (978) 256-5557

280 Main St
Ste 140
Nashua, NH 03060
Phone (603) 594-3025

Organizations & group practices 1

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": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288828800000",
    "number": "1114175270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 RIPKA ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191283331",
            "telephone_number": "352-246-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044551",
            "telephone_number": "215-823-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARQUIS",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2010-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "PA",
            "license": "AT006088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.