Individual provider Active NPI

Amanda M Rodriguez, PA-C

  • Physician Assistant
  • Jackson, MI
National Provider Identifier
1326109208
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004537 Issued in MI
Practice address
300 W Washington Ave Ste 250
Jackson, MI 49201-2160
Phone
(517) 539-3188
Fax
(517) 539-3189
NPI assigned
Dec 13, 2006
Last updated
Oct 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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 5601004537 MI Primary

Addresses

Primary practice location

300 W Washington Ave Ste 250
Jackson, MI 49201-2160

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other names 1

  • Amanda Lambert Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address A.Rodriguez@forefrontdermatology.emadirect.md

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051001000004 MI Practitioner - Physician Assistant 3971538604 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

1007 Harbor Hills Dr
Suite C
Marquette, MI 49855-8977
Phone (906) 225-5458

300 W Washington Ave
Suite 250
Jackson, MI 49201-2160
Phone (517) 539-3188

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004537MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. CurrentSince Jul 25, 2022 Accepting new patients
Forefront Dermatology, S.C. CurrentSince Jul 25, 2022 Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients

Locations

4362 Cascade Rd SE
Ste 206
Grand Rapids, MI 49546
Phone (616) 678-2070

300 W Washington Ave
Ste 250
Jackson, MI 49201
Phone (517) 539-3188

1007 Harbor Hills Dr
Ste C
Marquette, MI 49855
Phone (906) 225-0597

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Interoperability endpoints

  • Direct secure messaging: a.rodriguez@forefrontdermatology.emadirect.md

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 1

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1326109208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE STE 250",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012160",
            "telephone_number": "517-539-3188",
            "fax_number": "517-539-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "A.Rodriguez@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "300 W Washington Ave Ste 250",
            "city": "Jackson",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492012160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LAMBERT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.