Individual provider Active NPI

Amanda J Ben

  • Family Nurse Practitioner
  • Saint Charles, MO
National Provider Identifier
1164049698
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2020003743 Issued in MO
Practice address
23 Terre Verte CT
Saint Charles, MO 63304-1217
Phone
(716) 228-0524
NPI assigned
Jun 30, 2020
Last updated
Jun 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2020003743 MO Primary

Addresses

Primary practice location

23 Terre Verte CT
Saint Charles, MO 63304-1217

Mailing address

23 Terre Verte CT
Saint Charles, MO 63304-1217
Phone (716) 228-0524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20210428003109 MO Practitioner - Nurse Practitioner 2769897768 Reassigns benefits to 2 organizations
I20210510002596 IL Practitioner - Nurse Practitioner 2769897768 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Access Urgent Care PCGroup PAC ID 8820171929, 130 clinicians

Practice addresses (Care Compare)

9556 Manchester Rd
Saint Louis, MO 63119-1313
Phone (314) 961-2255

Merit-based Incentive Payment System (MIPS)

Final score
42.87 of 100Reported as group
Quality
31.86
Promoting interoperability
0
Improvement activities
40
Cost
61.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2020003743MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alton Urgent Care Walk in Clinic Company CurrentSince Mar 1, 2023 Accepting new patients
Belleville Urgent Care Walk-in Clinic CurrentSince Mar 1, 2023 Accepting new patients
Wood River Urgent Care and Walk in Clinic Inc CurrentSince Mar 1, 2023 Accepting new patients
Waterloo Urgent Care Walk in Clinic Company CurrentSince Mar 1, 2023 Accepting new patients
Granite City Urgent Care Walk-in Clinic CurrentSince Mar 1, 2023 Accepting new patients
Total Access Urgent Care, PC CurrentSince Apr 2, 2024 Accepting new patients
Total Access Urgent Care, PC CurrentSince Apr 2, 2024 Accepting new patients

Locations

1417 Washington Ave
Alton, IL 62002
Phone (618) 260-0320

2801 W Main St
Belleville, IL 62226
Phone (618) 234-3053

2861 Madison Ave
Granite City, IL 62040
Phone (618) 709-7723

907 N Illinois Route 3
Waterloo, IL 62298
Phone (618) 350-0200

211 Madison Ave
Wood River, IL 62095
Phone (618) 709-7723

14671 Telegraph Rd
Redford, MI 48239
Phone (313) 387-2100

9556 Manchester Rd
Saint Louis, MO 63119
Phone (314) 373-5740

1717 Madison Ave
Washington, MO 63090
Phone (636) 244-6950

13861 Manchester Rd
Wildwood, MO 63011
Phone (636) 220-9333

Organizations & group practices 8

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": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1164049698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 TERRE VERTE CT",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633041217",
            "telephone_number": "716-228-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 TERRE VERTE CT",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633041217",
            "telephone_number": "716-228-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEN",
        "first_name": "AMANDA",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-30",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2020003743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.