Individual provider Active NPI

Amanda Lynne Mudek, DPM

  • Foot & Ankle Surgery Podiatrist
  • Metairie, LA
National Provider Identifier
1134494834
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
325547 Issued in LA
Practice address
2520 Harvard Ave FL 1
Metairie, LA 70001-1172
Phone
(504) 708-4810
NPI assigned
Mar 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 325547 LA Primary

Addresses

Primary practice location

2520 Harvard Ave FL 1
Metairie, LA 70001-1172

Mailing address

2520 Harvard Ave FL 1
Metairie, LA 70001-1172
Phone (504) 454-3004

Other practice location 1

37292 Market Place Dr Ste B
Prairieville, LA 70769-3487
Phone (225) 744-3669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220803000037 LA Practitioner - Podiatry 5294016242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gulf South Foot and Ankle LLCGroup PAC ID 4082885272, 6 clinicians

Practice addresses (Care Compare)

2520 Harvard Ave
Suite 1
Metairie, LA 70001-1172
Phone (504) 454-3004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue104
Removal or shaving of skin growth46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2172TXMDProsthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf South Foot & Ankle, LLC Foot & Ankle Surgery CurrentSince Mar 24, 2022 Accepting new patients
Nicholas D Pappas III MD LLC CurrentSince Dec 3, 2023 Accepting new patients

Locations

71121 Highway 21
Ste A
Covington, LA 70433
Phone (985) 809-1464

2520 Harvard Ave
Ste 1
Metairie, LA 70001
Phone (504) 454-3004

2520 Harvard Ave
Fl 1
Metairie, LA 70001
Phone (504) 226-2871

27136 Highway 23
Port Sulphur, LA 70083
Phone (504) 392-7000

37292 Market Place Dr
#B
Prairieville, LA 70769

37292 Market Place Dr
Ste B
Prairieville, LA 70769
Phone (225) 744-3668

Interoperability endpoints

  • Direct secure messaging: amudek@gulfsouthmedicalgroup.emadirect.md
  • FHIR API: https://api.platform.athenahealth.com/3187/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1134494834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 HARVARD AVE FL 1",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700011172",
            "telephone_number": "504-454-3004",
            "fax_number": "504-454-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 HARVARD AVE FL 1",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700011172",
            "telephone_number": "504-708-4810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37292 Market Place Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Prairieville",
            "state": "LA",
            "postal_code": "707693487",
            "country_code": "US",
            "telephone_number": "225-744-3669",
            "fax_number": "225-744-3669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUDEK",
        "first_name": "AMANDA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-13",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "LA",
            "license": "325547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

Verify at the official NPI Registry.