Amanda Pettus, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

53292 Issued in CA

Practice address

836 S Arroyo Pkwy
Pasadena, CA 91105-3212

Phone

(650) 773-8498

NPI assigned

Oct 28, 2015

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology and Cosmetics Laser Care a Medical CorporationGroup PAC ID 5395659460, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Advanced Dermatology & Cosmetics Laser Care a Medical Corporation

  • Specialist
  • Valencia, CA
  • NPI 1912026097
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458345600000",
    "number": "1144692237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20425 SORRENTO LN APT 101",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913264582",
            "telephone_number": "650-773-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 S ARROYO PKWY",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053212",
            "telephone_number": "650-773-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-28",
        "last_updated": "2016-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "53292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Collen Petrass, ASW
• Artur Petrosyan
• Leonard V. Petrus, MEDICAL DOCTOR
• Jasmine Petry
• Ramanda Mallery Pettit, PH.D.
• Brittney Theresa Petty
• Claudia Una Pfeil, M.D.
• Karina Pfleider
• VI T Pham Negrete, PSYD
• Nicole M. Pham-Bailey, MD

• Surgical Physician Assistant in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2016; 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.