Amanda J Blackmore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-01405 Issued in KS

Practice address

1100 N Saint Francis St
Ste 130
Wichita, KS 67214-2878

Phone

(316) 264-3505

Fax

(316) 264-0908

NPI assigned

Aug 14, 2010

Last updated

Feb 10, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hospitalist Medicine Physicians of Texas PLLCGroup PAC ID 3476688318, 685 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Via Christi Hospitals Wichita, Inc. Hospital, Wichita, KS, CCN 170122
• Via Christi Hospital Wichita St Teresa, Inc Hospital, Wichita, KS, CCN 170200

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095

  KS

  Medicare reassignment Care Compare group
• Cogent Healthcare of Texas, PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1992722953

  KS

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ascension Via Christi Hospital St Teresa Inc.

  • General Acute Care Hospital
  • Wichita, KS
  • NPI 1023334950
  Care Compare affiliation
• Ascension Via Christi Hospitals Wichita Inc.

  • General Acute Care Hospital
  • Wichita, KS
  • NPI 1154314789
  Care Compare affiliation

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

{
    "created_epoch": "1281744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1326353350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N SAINT FRANCIS ST",
            "address_2": "STE 130",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142878",
            "telephone_number": "316-264-3505",
            "fax_number": "316-264-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N SAINT FRANCIS ST",
            "address_2": "STE 130",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142878",
            "telephone_number": "316-264-3505",
            "fax_number": "316-264-0908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMORE",
        "first_name": "AMANDA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-14",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200672080A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen N Blackburn, PA-C
• Zachary Blackhurst, PHD
• Douglas K Blackman, OD
• Jacques D Blackman, MD
• Sheila Blackmon, RN
• Jonathan D Blackwell, T-LPC
• Meryiah Blaine, LMLP-T
• Anita S Blair, PSYD
• Bailey Ann Blair
• Grace Blair, LMSW

• Physician Assistant in Wichita, KS
• Providers in Wichita, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; 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.
• 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.