Individual provider Active NPI

Amanda Mae Tiffany

  • Pediatrics Physician
  • Daleville, VA
National Provider Identifier
1154731198
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0102204843 Issued in VA
Practice address
60 Market Center Way
Daleville, VA 24083-3261
Phone
(540) 992-1251
Fax
(540) 992-5958
NPI assigned
Apr 29, 2014
Last updated
Aug 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0102204843 VA Primary

Addresses

Primary practice location

60 Market Center Way
Daleville, VA 24083-3261

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5715

Other practice location 1

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address atiffany50112@direct.carilionclinic.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170725003235 VA Practitioner - Pediatric Medicine 6002036654 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Jul 24, 2017 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jul 24, 2017 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jul 24, 2017 Accepting new patients
Carilion Medical Center CurrentSince Jul 24, 2017 Accepting new patients
Carilion Medical Center Past Accepting new patients

Locations

60 Market Center Way
Daleville, VA 24083
Phone (540) 992-1251

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

4348 Electric Rd
Roanoke, VA 24018
Phone (540) 769-0600

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

Interoperability endpoints

  • Direct secure messaging: atiffany50112@direct.carilionclinic.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1154731198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MARKET CENTER WAY",
            "city": "DALEVILLE",
            "state": "VA",
            "postal_code": "240833261",
            "telephone_number": "540-992-1251",
            "fax_number": "540-992-5958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave SE",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240141838",
            "country_code": "US",
            "telephone_number": "540-981-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIFFANY",
        "first_name": "AMANDA",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102204843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "atiffany50112@direct.carilionclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "atiffany50112@direct.carilionclinic.org",
            "address_1": "60 Market Center Way",
            "city": "Daleville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240833261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Daleville, VA

Sources for this page

Verify at the official NPI Registry.