NPIMap

Individual provider Active NPI

Amy Elizabeth Iwamaye, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Philadelphia, PA
National Provider Identifier
1255575130
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
MT194633 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-5734
NPI assigned
Apr 23, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD445484 PA
Endocrinology, Diabetes & Metabolism Physician 207RE0101X MT194633 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

513 E Murdoch Rd
Philadelphia, PA 19119-1027
Phone (732) 241-7278

Other practice location 1

100 E Lancaster Ave
Clinic Area B15
Wynnewood, PA 19096-3450
Phone (484) 476-2658

Other identifiers 1

IdentifierTypeStateIssuer
037276OtherPAMLHC MEDICARE AA #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20120703000080 PA Practitioner - EndocrinologyPractitioner - Internal Medicine 5698930394 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Perelman School of Med at the University of Pennsylvania, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suburban Endocrinology Associates, PCGroup PAC ID 6507816600, 3 clinicians

Practice addresses (Care Compare)

11 Industrial Blvd
Suite 202
Paoli, PA 19301-1620
Phone (610) 251-0300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT194633PAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Aug 1, 2019 Accepting new patients
Suburban Endocrinology Associates, PC Endocrinology, Diabetes & Metabolism CurrentSince Sep 15, 2023 Accepting new patients
Temple Faculty Practice Plan, Inc Endocrinology, Diabetes & Metabolism CurrentSince Aug 1, 2019 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Main Line Healthcare Internal Medicine PastSince Jul 1, 2008 Accepting new patients

Locations

11 Industrial Blvd
Ste 202
Paoli, PA 19301
Phone (484) 527-0410

21 Industrial Blvd
Ste 101
Paoli, PA 19301
Phone (610) 251-0300

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

7604 Central Ave
Philadelphia, PA 19111
Phone (215) 214-3100

Interoperability endpoints

  • Direct secure messaging: amy.iwamaye@sea.eclinicaldirectplus.com

Organizations & group practices 5

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 6

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": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255575130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 E MURDOCH RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191191027",
            "telephone_number": "732-241-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-5734"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Lancaster Ave",
            "address_2": "Clinic Area B15",
            "address_purpose": "LOCATION",
            "city": "Wynnewood",
            "state": "PA",
            "postal_code": "190963450",
            "country_code": "US",
            "telephone_number": "484-476-2658",
            "fax_number": "484-476-2636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IWAMAYE",
        "first_name": "AMY",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD445484",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "PA",
            "license": "MT194633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MLHC MEDICARE AA #",
            "identifier": "037276",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.