Individual provider Active NPI

Amanda Maroudas, RD

  • Registered Dietitian
  • Watsonville, CA
National Provider Identifier
1316532765
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86168349 Issued in CA
Practice address
85 Neilson St
Watsonville, CA 95076-2485
Phone
(831) 726-4257
NPI assigned
Mar 8, 2021
Last updated
Jan 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86168349 CA Primary

Addresses

Primary practice location

85 Neilson St
Watsonville, CA 95076-2485

Mailing address

85 Neilson St
Watsonville, CA 95076-2485
Phone (831) 726-4257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210602003007 CA Practitioner - Registered Dietitian Or Nutrition Professional 4082021464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pajaro Valley Community Health TrustGroup PAC ID 5193792430, 3 clinicians

Practice addresses (Care Compare)

85 Neilson St
Suite 201
Watsonville, CA 95076-2485
Phone (831) 763-6445

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86168349CAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Pajaro Valley Community Health Trust CurrentSince Mar 8, 2021 Accepting new patients
Pajaro Valley Community Health Trust Past Accepting new patients

Locations

85 Nielson St
Watsonville, CA 95076
Phone (831) 726-4257

85 Nielson St
Ste 201
Watsonville, CA 95076
Phone (831) 763-6445

Interoperability endpoints

  • Direct secure messaging: amanda.garza.1@19753.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19753/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1316532765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 NEILSON ST",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950762485",
            "telephone_number": "831-726-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 NEILSON ST",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950762485",
            "telephone_number": "831-726-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAROUDAS",
        "first_name": "AMANDA",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-08",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86168349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.