Amanda Waggoner, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY10240 Issued in FL

Practice address

725 N 12TH Ave BLDG B
Arcadia, FL 34266-8752

Phone

(863) 494-1242

NPI assigned

Oct 25, 2018

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

MCR Health IncGroup PAC ID 7214847995, 132 clinicians

Sailor Health Medical PAGroup PAC ID 4486182342, 301 clinicians

Health Care Center for the Homeless IncGroup PAC ID 6103895107, 51 clinicians

Ace Behavioral Health LLCGroup PAC ID 2668984675, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ace Behavioral Health LLC

  • Psychiatry Physician
  • Tampa, FL
  • NPI 1841094885

  Psychologist

  Medicare reassignment Care Compare group NPD
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000
  Medicare reassignment Care Compare group NPD
• Health Care Center for the Homeless Inc

  dba Orange Blossom Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Orlando, FL
  • NPI 1235213216
  Medicare reassignment Care Compare group
• Sailor Health Medical PA

  • Psychologist
  • Coral Gables, FL
  • NPI 1841012960
  Medicare reassignment Care Compare group
• Citrus County Rural Health Inc

  • Federally Qualified Health Center (FQHC)
  • Crystal River, FL
  • NPI 1740931831
  Medicare reassignment NPD
• Coastal Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fernandina Beach, FL
  • NPI 1851131874
  Medicare reassignment
• MCR Health, Inc.

  dba Riverside Medical Center

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD

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

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540425600000",
    "number": "1164999421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 8TH AVE W STE 101",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214737",
            "telephone_number": "941-776-4000",
            "fax_number": "941-845-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N 12TH AVE BLDG B",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668752",
            "telephone_number": "863-494-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "AMANDA",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-25",
        "last_updated": "2018-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY10240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mirna Alejandra Velasquez, LCSW, CTS
• Shweta R Venkat, M.D.
• Terence Ryan Vereen, APRN
• Kaydean J Vickers, FNP
• Pedro Raul Villanueva, M.D.
• Tracey Nicole Waite, LCSW
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0811)
• Wal-Mart Stores East, LP (Vision Center 30-0811)
• Walgreen Co (Walgreens #10668)
• Michael Walsh, CRNA

• Psychologist in Arcadia, FL
• Providers in Arcadia, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; 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.