Active NPI
Amanda Malamud
- Physician Assistant
- Vallejo, CA
National Provider Identifier
1275283145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1310 Club Dr
Vallejo, CA 94592-1187 - Phone
- (707) 638-5809
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1310 Club Dr
Vallejo, CA 94592-1187
Mailing address
1310 Club Dr
Vallejo, CA 94592-1187
Phone (707) 638-5809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250507000548 | NY | Order and Referring Only - Physician Assistant | 6204353956 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
Interoperability endpoints
- amalamud4495456@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648080000000",
"number": "1275283145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 CLUB DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945921187",
"telephone_number": "707-638-5809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 CLUB DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945921187",
"telephone_number": "707-638-5809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALAMUD",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-24",
"last_updated": "2022-03-24",
"certification_date": "2022-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.