Individual provider Active NPI

Amanda Nicole Davis, CNP

  • Family Nurse Practitioner
  • Jackson, OH
National Provider Identifier
1164724787
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.12007-NP Issued in OH
Practice address
280 Pattonsville Rd
Jackson, OH 45640-9452
Phone
(740) 395-8805
Fax
(740) 395-8855
NPI assigned
Dec 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2014

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 COA.12007-NP OH Primary

Addresses

Primary practice location

280 Pattonsville Rd
Jackson, OH 45640-9452

Mailing address

90 Jackson Pike
Gallipolis, OH 45631-1560
Phone (740) 992-0060

Other identifiers 3

IdentifierTypeStateIssuer
3810019225MedicaidWV
000000691801OtherOHANTHEM BCBS
3108845MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20110221000527 OH Practitioner - Nurse Practitioner 3375724628 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holzer Clinic LLCGroup PAC ID 5890606008, 266 clinicians

Practice addresses (Care Compare)

100 Jackson Pike
Gallipolis, OH 45631-1560
Phone (740) 446-5050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.27 of 100Reported as group
Quality
68.56
Promoting interoperability
100
Improvement activities
40
Cost
68.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.12007-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Professional Services, Inc. Family CurrentSince Nov 1, 2016 Accepting new patients
Holzer Clinic, LLC CurrentSince Dec 15, 2010 Accepting new patients
I Path LLC Current Accepting new patients

Locations

90 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5131

100 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5050

280 Pattonsville Rd
Jackson, OH 45640
Phone (740) 395-8805

18697 Bagley Rd
Middleburg Heights, OH 44130
Phone (440) 816-8000

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407369600000",
    "number": "1164724787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-992-0060",
            "fax_number": "740-446-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 PATTONSVILLE RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409452",
            "telephone_number": "740-395-8805",
            "fax_number": "740-395-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-02",
        "last_updated": "2014-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.12007-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810019225",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000691801",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3108845",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, OH

Sources for this page

Verify at the official NPI Registry.