NPIMap

Individual provider Active NPI

Amanda N Cromer, NP-C, AOCNP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1174590004
Registry record updated Apr 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
900460 Issued in NC
Practice address
1000 Blythe Blvd
Suite 3809 Carolinas Medical Center-Radiation Oncology
Charlotte, NC 28203-5812
Phone
(704) 355-2272
Fax
(704) 333-3397
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 900460 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Suite 3809 Carolinas Medical Center-Radiation Oncology
Charlotte, NC 28203-5812

Mailing address

200 Queens Rd
Suite 400 Southeast Radiation Oncology Group
Charlotte, NC 28204-3264
Phone (704) 333-7376

Other identifiers 3

IdentifierTypeStateIssuer
2592234OtherNCMEDICARE PTAN
259223AOtherNCMEDICARE PTAN
259223BOtherNCMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041123000302 NC Practitioner - Nurse Practitioner 4183689763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southeast Radiation Oncology Group, P.a.Group PAC ID 1254233950, 52 clinicians

Practice addresses (Care Compare)

200 Queens Rd
Charlotte, NC 28204-3264
Phone (704) 333-7376

920 Church N St
Concord, NC 28025-2927
Phone (704) 333-7376

Hospital & facility affiliations

  • Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
  • Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
900460NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Radiation Oncology Group, P.a. CurrentSince May 18, 2009 Accepting new patients

Locations

200 Queens Rd
Ste 400
Charlotte, NC 28204
Phone (704) 765-2578

1000 Blythe Blvd
Ste 3809
Charlotte, NC 28203
Phone (704) 355-2272

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

1400 Matthews Township Pkwy
Matthews, NC 28105
Phone (704) 845-8800

Organizations & group practices 1

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 10

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1174590004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400 SOUTHEAST RADIATION ONCOLOGY GROUP",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043264",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "address_2": "SUITE 3809 CAROLINAS MEDICAL CENTER-RADIATION ONCOLOGY",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2272",
            "fax_number": "704-333-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROMER",
        "first_name": "AMANDA",
        "middle_name": "N",
        "credential": "NP-C, AOCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "900460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "2592234",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "259223A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "259223B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.