Amanda Marie Ilag, AGNP
Individual provider Active NPI Primary Care Nurse Practitioner · Berkeley, CA
NPI 1114745783 · NPPES record last updated Jan 16, 2025
Key facts
- NPI
- 1114745783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 95032119 (CA)
- Practice address
- 1901 4TH St Ste 201
Berkeley, CA 94710-1986 - Phone
- (510) 929-1400
- Fax
- (510) 929-1414
- NPI assigned
- Oct 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pine Park Health, Inc
Practice addresses (Care Compare)
Berkeley, CA 94710
Phone (510) 929-1400
Hospital & facility affiliations
- Alliance Home Health
- Carelink Home Health Agency LLC
- Health Link Home Health Agency
- Sutter Care at Home
- Anx Home Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250128000862 | CA | Practitioner - Nurse Practitioner | 5193254779 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Park Health, Inc | Single Specialty | Current |
Accepting new patients |
Locations
1901 4th St
Ste 201
Berkeley, CA 94710
Phone (469) 401-8820
22445 Cupertino Rd
Cupertino, CA 95014
Phone (408) 253-4300
3850 Walnut Ave
Fremont, CA 94538
Phone (341) 206-8344
16977 Healdsburg Ave
Healdsburg, CA 95448
1144 65th St
Ste F
Oakland, CA 94608
Phone (510) 919-1400
9800 Glen Center Dr
San Diego, CA 92131
Phone (858) 444-8500
1444 McAllister St
San Francisco, CA 94115
Phone (415) 305-4002
Interoperability endpoints
- https://api.platform.athenahealth.com/21048/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner |
363LP2300X | 95032119 | CA | Yes |
Addresses
Primary practice location
1901 4TH St Ste 201
Berkeley, CA 94710-1986
Mailing address
PO Box 511250
Los Angeles, CA 90051-7805
Phone (510) 929-1400
Other providers in Berkeley, CA
- Robert H. Iezman
- Raymond E Ifield
- Gerald John Iglesias
- Allison Mayumi Ikeda
- Ashley Kimiko Ikeda
- Kristy L Illg
- Michel Lynn Inaba
- Erin Inada
- Inadvance Medicine Associates West, P.C
- Pamela Renee Inbar-Hansen
All providers in Berkeley, CA · Primary Care Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.