Amanda Ford, DO
Individual provider Active NPI Family Medicine Physician · Connelly Springs, NC
NPI 1245657105 · NPPES record last updated Apr 16, 2018
Key facts
- NPI
- 1245657105
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2017-01028 (NC)
- Practice address
- 730 Malcolm Blvd Ste 150
Connelly Springs, NC 28612-8079 - Phone
- (828) 580-8684
- Fax
- (828) 580-8459
- NPI assigned
- Mar 27, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wake Forest University Health Sciences
Practice addresses (Care Compare)
910 Worth St
Mt Airy, NC 27030-4458
Phone (336) 786-5108
Hospital & facility affiliations
- Centerwell Home Health
- Liberty Home Care V, LLC
- North Carolina Baptist Hospital
- Northern Regional Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170731000767 | NC | Practitioner - Family Practice | 1759605496 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200943 | NC | MD | Oncology Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Current |
Accepting new patients |
Locations
910 Worth St
Mount Airy, NC 27030
Phone (336) 786-5108
Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2017-01028 | NC | Yes |
Addresses
Primary practice location
730 Malcolm Blvd Ste 150
Connelly Springs, NC 28612-8079
Mailing address
730 Malcolm Blvd Ste 150
Connelly Springs, NC 28612-8079
Phone (828) 580-8684
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245657105 | Medicaid | NC |
Other providers in Connelly Springs, NC
- College Pines Rehabilitation and Skilled Nursing Center, LLC
- Cox Family Medicine
- Alex Thomas Craig
- Find a Way Counseling Services, PLLC
- Danielle Marie Fontaine
- Joseph Eric Franklin
- Nicole Lauren Gaines
- Gaston Family Health Services, Inc
- Gaston Family Health Services, Inc
- Jackson Genant
All providers in Connelly Springs, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.