Individual provider Active NPI

Amanda Irene Main, PA-C

  • Physician Assistant
  • Maitland, FL
National Provider Identifier
1144699653
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAT9108927 Issued in FL
Practice address
500 Winderley PL Ste 115
Maitland, FL 32751-7406
Phone
(407) 875-0555
NPI assigned
Sep 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 027177 NY
Physician Assistant 363A00000X PAT9108927 FL Primary

Addresses

Primary practice location

500 Winderley PL Ste 115
Maitland, FL 32751-7406

Mailing address

500 Winderley PL Ste 115
Maitland, FL 32751-7406
Phone (407) 875-0555

Other practice location 1

622 W 168th St
New York, NY 10032-3720
Phone (212) 305-6059

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxypub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
Direct Messaging Address amm9221@direct.nyp.org Direct
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NY, NC3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20151208002012 FL Practitioner - Physician Assistant 9436459823 Reassigns benefits to 4 organizations
I20220111000810 NY Practitioner - Physician Assistant 9436459823 Reassigns benefits to 2 organizations
I20240828003026 NC Practitioner - Physician Assistant 9436459823 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yadkin Emergency Physicians PLLCGroup PAC ID 3173875127, 23 clinicians

Practice addresses (Care Compare)

180 Parkwood Dr
Elkin, NC 28621-2430
Phone (336) 527-7000

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.67
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAT9108927FLMDPhysician Assistant
027177NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Jan 6, 2024 Accepting new patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Aug 10, 2020 Accepting new patients
Vidant Medical Group LLC CurrentSince Sep 17, 2024 Accepting new patients
Gastonia Physician Services, PLLC CurrentSince Jan 1, 2026 Accepting new patients
Urgent Care Centers of Brevard County LLC Physician Assistant CurrentSince Sep 28, 2020 Accepting new patients
Gastonia Physician Services, PLLC CurrentSince Jan 1, 2026 Accepting new patients
Urgent Care Centers of Brevard County LLC Physician Assistant CurrentSince Sep 28, 2020 Accepting new patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Aug 10, 2020 Accepting new patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Jan 6, 2024 Accepting new patients
Observation Medicine Specialists LLC Past Accepting new patients

Locations

440 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 788-2000

105 S Banana River Blvd
Cocoa Beach, FL 32931
Phone (321) 783-3362

5665 New Northside Dr
Ste 320
Sandy Springs, GA 30328
Phone (770) 874-5468

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

451 E Charlotte Ave
Mt Holly, NC 28120
Phone (980) 834-2266

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
#2260
New York, NY 10032
Phone (212) 305-6204

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Interoperability endpoints

  • Direct secure messaging: amm9221@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: amain1523051@nychhc.direct-ci.com
  • Direct secure messaging: amain1188185@direct.unc.nchie.net
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1144699653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL STE 115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517406",
            "telephone_number": "407-875-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL STE 115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517406",
            "telephone_number": "407-875-0555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "212-305-6059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIN",
        "first_name": "AMANDA",
        "middle_name": "IRENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-15",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027177",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAT9108927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxypub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amm9221@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.