Amanda Mathews Vicznesky, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9456 Issued in GA

Practice address

3950 Austell Rd
Austell, GA 30106-1121

Phone

(470) 732-4000

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Northside Emergency Associates, LLC

  • Emergency Medicine Physician
  • Sandy Springs, GA
  • NPI 1285686303
  Medicare reassignment
• The Bortolazzo Group, LLC

  • Emergency Medicine Physician
  • Austell, GA
  • NPI 1801965082
  Medicare reassignment

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1174177752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 IVY BROOK DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575523",
            "telephone_number": "217-357-4592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "470-732-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Northside Cherokee Blvd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "GA",
            "postal_code": "301158015",
            "country_code": "US",
            "telephone_number": "770-224-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICZNESKY",
        "first_name": "AMANDA",
        "middle_name": "MATHEWS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Van Horn
• Vascular Surgical Associates, PC
• Ailah Marie Vazquez, RN, MSN, FNP-C
• Natalia Velazquez, DHSC, PA-C, MS, CFMP
• Jennifer N Vernon, M.D.
• Anne Vidanagama, MD
• View Point Behavioral Health
• Village Podiatry Group, LLC.
• Village Podiatry Group, LLC.
• Michael Violette

• Physician Assistant in Austell, GA
• Providers in Austell, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.