Individual provider Active NPI

Amanda Jean Nedervelt, D.O.

  • Internal Medicine Physician
  • Manning, SC
National Provider Identifier
1346660503
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
37733 Issued in SC
Practice address
10 E Hospital St
Manning, SC 29102-3153
Phone
(803) 433-3000
NPI assigned
Apr 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 37733 SC Primary
Internal Medicine Physician 207R00000X OS13103 FL
Internal Medicine Physician 207R00000X DO.1638 AL

Addresses

Primary practice location

10 E Hospital St
Manning, SC 29102-3153

Mailing address

9740 Marsh Wren CT Apt 208
Lake Worth, FL 33467-5282
Phone (941) 773-7233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170321001091 AL Practitioner - HospitalistPractitioner - Internal Medicine 7315235298 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
37733SCMDPharmacist
DO.1638ALMDInternal Medicine Physician
OS13103FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medcore Associates, PLLC Current Accepting new patients
Houston County Healthcare Authority Internal Medicine CurrentSince Apr 30, 2021 Accepting new patients
Houston County Healthcare Authority Internal Medicine Current Accepting new patients
Houston County Healthcare Authority Internal Medicine Current Accepting new patients
Pathology Laboratory Associates Current Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

Interoperability endpoints

  • Direct secure messaging: anedervelt61856@southeasthealth.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1346660503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9740 MARSH WREN CT APT 208",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334675282",
            "telephone_number": "941-773-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153",
            "telephone_number": "803-433-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEDERVELT",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-25",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "37733",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS13103",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "DO.1638",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manning, SC

Sources for this page

Verify at the official NPI Registry.