Active NPI
Amanda Gerrald
- Pediatric Nurse Practitioner
- Conway, SC
National Provider Identifier
1144637166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 18893
- Practice address
- 1608 Main St
Conway, SC 29526-3572 - Phone
- (843) 248-4700
- NPI assigned
- Jul 22, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 18893 | SC | Primary |
Addresses
Primary practice location
1608 Main St
Conway, SC 29526-3572
Mailing address
1608 Main St
Conway, SC 29526-3572
Phone (843) 248-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP3725 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18893 | SC | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Care Partners of South Carolina, Inc. | Past | Accepting new patients | |
| Health Care Partners of South Carolina, Inc. | Past | Accepting new patients | |
| Health Care Partners of South Carolina, Inc. | Past | Accepting new patients | |
| Health Care Partners of South Carolina, Inc. | Past | Accepting new patients |
Interoperability endpoints
- amanda.gerrald@hcposc.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/EAHGAD/Endpoint/EAHGAD
Organizations & group practices 4
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.
-
- Federally Qualified Health Center (FQHC)
- Conway, SC
- NPI 1043395346
-
- Federally Qualified Health Center (FQHC)
- Johnsonville, SC
- NPI 1639255631
-
- Federally Qualified Health Center (FQHC)
- Marion, SC
- NPI 1770668824
-
- Federally Qualified Health Center (FQHC)
- Marion, SC
- NPI 1861874430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1144637166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1608 MAIN ST",
"city": "CONWAY",
"state": "SC",
"postal_code": "295263572",
"telephone_number": "843-248-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1608 MAIN ST",
"city": "CONWAY",
"state": "SC",
"postal_code": "295263572",
"telephone_number": "843-248-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERRALD",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-22",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "SC",
"license": "18893",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP3725",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.