Individual provider Active NPI

Amanda Kathryn O'Malley, FNP

  • Family Nurse Practitioner
  • Albany, NY
National Provider Identifier
1356013171
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
348569 Issued in NY
Practice address
4 Executive Park Dr Ste 2
Albany, NY 12203-3717
Phone
(518) 489-7494
NPI assigned
Sep 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 348569 NY Primary

Addresses

Primary practice location

4 Executive Park Dr Ste 2
Albany, NY 12203-3717

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

2231 Burdett Ave Ste 160
Troy, NY 12180-2453
Phone (518) 272-1333

Other practice location 2

855 Route 146 Bldg B
Clifton Park, NY 12065-3885
Phone (518) 373-4580

Other practice location 3

319 S Manning Blvd Ste 106
Albany, NY 12208-1743
Phone (518) 438-1019

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20211025002359 NY Practitioner - Nurse Practitioner 0042608077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Dermatology, PCGroup PAC ID 3375434046, 14 clinicians

Practice addresses (Care Compare)

319 S Manning Blvd
Suite 106
Albany, NY 12208-1743
Phone (518) 438-1019

461 Clinton St Ext
Suite 1
Schenectady, NY 12305-2425
Phone (518) 374-7222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
348569NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Dermatology, PC CurrentSince Jun 24, 2024 Accepting new patients
St. Peter'S Health Partners Medical Associates, P.C. CurrentSince Dec 20, 2021 Accepting new patients

Locations

319 S Manning Blvd
Ste 106
Albany, NY 12208
Phone (518) 438-0507

4 Executive Park Dr
Ste 2
Albany, NY 12203
Phone (518) 435-1231

1547 Columbia Tpke
Castleton on Hudson, NY 12033
Phone (518) 479-4156

113 Hudson Ave
Chatham, NY 12037
Phone (518) 392-6742

855 Route 146
Bldg B
Clifton Park, NY 12065
Phone (518) 373-4580

461 Clinton St Ext
Schenectady, NY 12305
Phone (518) 374-7222

461 Clinton St Ext
#1
Schenectady, NY 12305
Phone (518) 374-7222

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

2231 Burdett Ave
Ste 160
Troy, NY 12180
Phone (518) 272-1333

Interoperability endpoints

  • Direct secure messaging: aomalley1560103@direct.trinity-health.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1632960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1356013171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 EXECUTIVE PARK DR STE 2",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033717",
            "telephone_number": "518-489-7494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2231 Burdett Ave Ste 160",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802453",
            "country_code": "US",
            "telephone_number": "518-272-1333",
            "fax_number": "518-272-1331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "855 Route 146 Bldg B",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120653885",
            "country_code": "US",
            "telephone_number": "518-373-4580",
            "fax_number": "518-489-7641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "319 S Manning Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081743",
            "country_code": "US",
            "telephone_number": "518-438-1019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'MALLEY",
        "first_name": "AMANDA",
        "middle_name": "KATHRYN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP - Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "319 S Manning Blvd Ste 106",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.