Amanda Lee Thacker, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024185322 Issued in VA

Practice address

19450 Deerfield Avenue, Suite 200
Leesburg, VA 20176-6821

Phone

(703) 844-8380

Fax

(703) 263-8393

NPI assigned

Mar 28, 2023

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.65 of 100Reported as apm

Quality

85.31

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.thacker@lmg1.eclinicaldirectplus.com

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.

• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440
  Medicare reassignment Care Compare group NPD
• Loudoun Medical Group, PC

  dba Loudoun Medical Group, PC 'D'

  • Vascular Surgery Physician
  • Reston, VA
  • NPI 1588376321
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1114621810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL ST., NW",
            "address_2": "SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19450 DEERFIELD AVENUE, SUITE 200",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201766821",
            "telephone_number": "703-844-8380",
            "fax_number": "703-263-8393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3022 Williams Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314600",
            "country_code": "US",
            "telephone_number": "703-698-9400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THACKER",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024185322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017651500001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114621810",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Albert Taylor Jr., DVM
• Monica Andrea Taylor, LPC
• Kelly Tejada, LCSW-C
• Vincent Terreri, MS
• Deaira Terry
• Huong Ngoc Thai-Kemprowski, M.D.
• Ashley M Thalacker, FNP-BC
• Muskan Thapa
• The Arc of Loudoun (Paxton Campus)
• The Cardiovascular Group PC (Virginia Heart)

• Family Nurse Practitioner in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.