Individual provider Active NPI

Amanda Ruth Mascio, NNP-BC

  • Neonatal Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1194167023
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
AP5282 Issued in AZ
Practice address
7720 N 16TH St
Ste 425
Phoenix, AZ 85020-4492
Phone
(602) 476-8962
Fax
(623) 643-9236
NPI assigned
Jul 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X AP5282 AZ Primary
Registered Nurse 163W00000X RN181625 AZ

Addresses

Primary practice location

7720 N 16TH St
Ste 425
Phoenix, AZ 85020-4492

Mailing address

7720 N 16TH St
Ste 425
Phoenix, AZ 85020-4492
Phone (602) 476-8962

Other identifiers 1

IdentifierTypeStateIssuer
861865MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20140219000885 AZ Order and Referring Only - Nurse Practitioner 6608005574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN181625AZMDRegistered Nurse
AP5282AZMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona OB GYN Affiliates PC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413417600000",
    "number": "1194167023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 N 16TH ST",
            "address_2": "STE 425",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204492",
            "telephone_number": "602-476-8962",
            "fax_number": "623-643-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7720 N 16TH ST",
            "address_2": "STE 425",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204492",
            "telephone_number": "602-476-8962",
            "fax_number": "623-643-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASCIO",
        "first_name": "AMANDA",
        "middle_name": "RUTH",
        "credential": "NNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-19",
        "last_updated": "2014-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "AZ",
            "license": "AP5282",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN181625",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861865",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.