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Individual provider Active NPI

Amanda Kelly, FNP

  • Physician Assistant
  • San Francisco, CA
National Provider Identifier
1326213554
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA14985 Issued in CA
Practice address
1700 California St
Suite 100
San Francisco, CA 94109-4586
Phone
(415) 386-8406
Fax
(415) 386-5388
NPI assigned
Apr 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 492432 CA
Physician Assistant 363A00000X PA14985 CA Primary

Addresses

Primary practice location

1700 California St
Suite 100
San Francisco, CA 94109-4586

Mailing address

3 Harbor Dr Ste 111
Sausalito, CA 94965-1491
Phone (415) 683-2988

Other practice location 1

3 Harbor Dr Ste 111
Sausalito, CA 94965-1491
Phone (415) 683-2988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160616000426 CA Practitioner - Physician Assistant 7517258890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Stanford University School of Medicine, 1999
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.03 of 100Reported as subgroup
Quality
80.86
Promoting interoperability
76
Improvement activities
40
Cost
75.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA14985CAMDPhysician Assistant
492432CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1326213554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HARBOR DR STE 111",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651491",
            "telephone_number": "415-683-2988",
            "fax_number": "415-683-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CALIFORNIA ST",
            "address_2": "SUITE 100",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941094586",
            "telephone_number": "415-386-8406",
            "fax_number": "415-386-5388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Harbor Dr Ste 111",
            "address_purpose": "LOCATION",
            "city": "Sausalito",
            "state": "CA",
            "postal_code": "949651491",
            "country_code": "US",
            "telephone_number": "415-683-2988",
            "fax_number": "415-683-2980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "492432",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA14985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.