NPIMap

Individual provider Active NPI

Amanda Jean Elder, PAC

  • Physician Assistant
  • Tulsa, OK
National Provider Identifier
1215900048
Registry record updated Jul 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1429 Issued in OK
Practice address
1705 E 19TH St
Suite 302
Tulsa, OK 74104-5405
Phone
(918) 748-7585
Fax
(918) 403-6352
NPI assigned
Feb 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1429 OK Primary

Addresses

Primary practice location

1705 E 19TH St
Suite 302
Tulsa, OK 74104-5405

Mailing address

PO Box 25277
Overland Park, KS 66225-5277
Phone (918) 307-6920

Other identifiers 2

IdentifierTypeStateIssuer
P00878501OtherOKMEDICARE RAILROAD
200067560AMedicaidOK

Other names 1

  • Amanda Jean Romine Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051223000081 OK Practitioner - Physician Assistant 7315968807 Reassigns benefits to 1 organization
I20220107000328 GA Practitioner - Physician Assistant 7315968807 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of North GeorgiaGroup PAC ID 2769715044, 36 clinicians
Athens Radiology Associates PCGroup PAC ID 2860486107, 34 clinicians

Practice addresses (Care Compare)

1199 Prince Ave
Athens, GA 30606-2797
Phone (706) 475-7000

1230 Baxter St
Athens, GA 30606-3712
Phone (706) 389-3000

2151 W Spring St
Monroe, GA 30655-3202
Phone (770) 267-8461

367 Clear Creek Pkwy
Lavonia, GA 30553-4173
Phone (706) 356-7800

930 Franklin Springs St
C
Royston, GA 30662-3908
Phone (706) 246-9729

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1429OKMDMental Health Counselor
10441GAMDPharmacotherapy Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Nov 11, 2014 Accepting new patients
Emergency Management Associates PC Past Accepting new patients
Radiology Consultants of Tulsa Inc Past Accepting new patients

Locations

1000 W Boise Cir
Broken Arrow, OK 74012
Phone (918) 994-8000

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1215900048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25277",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662255277",
            "telephone_number": "918-307-6920",
            "fax_number": "918-307-6951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST",
            "address_2": "SUITE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045405",
            "telephone_number": "918-748-7585",
            "fax_number": "918-403-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDER",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00878501",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200067560A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ROMINE",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.