NPIMap

Amanda Blanche Bennett, PA-C

Individual provider Active NPI Surgical Physician Assistant · Conway, SC

NPI 1376908657 · NPPES record last updated Sep 4, 2025

Key facts

NPI
1376908657
Entity type
Individual (NPI type 1)
Primary specialty
Surgical Physician Assistant 363AS0400X
License
5901 (SC)
Practice address
8004 Myrtle Trace Dr Ste 200
Conway, SC 29526-8945
Phone
(843) 347-8041
Fax
(843) 347-8042
NPI assigned
Dec 30, 2015
Sex
Female
Sole proprietor
No

Organizations & group practices 15

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 15

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

Medicare Care Compare profile

Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital Inc (127 clinicians)
Massachusetts General Physicians Organization Inc (3,494 clinicians)

Practice addresses (Care Compare)

1100 62ND Ave N
Myrtle Beach, SC 29572-7202

1575 Cambridge St
Cambridge, MA 02138-4308
Phone (617) 876-4344

2376 Cypress Cir
Suite 300
Conway, SC 29526-8995
Phone (843) 347-8041

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7112

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

6010 Hwy 707
Myrtle Beach, SC 29588-7321

8004 Myrtle Trace Dr
Conway, SC 29526-8945
Phone (843) 234-8939

8024 Myrtle Trace Dr
Conway, SC 29526-8945
Phone (843) 234-8950

Hospital & facility affiliations

  • Conway Medical Center Hospital · Conway, SC · CCN 420049
  • Massachusetts General Hospital Hospital · Boston, MA · CCN 220071
  • Newton-Wellesley Hospital Hospital · Newton, MA · CCN 220101

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MA, SC
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20190416002788 MA Practitioner - Physician Assistant 3971802414 Reassigns benefits to 3 organizations
I20250729000149 SC Practitioner - Physician Assistant 3971802414 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5901SCMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Current
since Aug 24, 2023		 Accepting new patients
Conway Hospital, Inc. Current
since Sep 1, 2025		 Accepting new patients
Newton Wellesley Hospital Current Accepting new patients
Conway Hospital, Inc. Physician Assistant Current
since Sep 1, 2025		 Accepting new patients
Rhode Island Hospital Past Accepting new patients
Conway Hospital, Inc. Physician Assistant Past Accepting new patients
Conway Hospital, Inc. Past Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

8004 Myrtle Trace Dr
Ste 200
Conway, SC 29526
Phone (843) 347-8041

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

1100 62nd Ave N
Myrtle Beach, SC 29572
Phone (843) 347-8041

Interoperability endpoints

  • Direct secure messaging: bennett.amanda.nwh@direct.partners.masshiway.net

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5901 SC Yes

Addresses

Primary practice location

8004 Myrtle Trace Dr Ste 200
Conway, SC 29526-8945

Mailing address

300 Singleton Ridge Rd
Conway, SC 29526-9142

Other practice location 1

1100 62nd Ave N
Myrtle Beach, SC 29572-7202
Phone (843) 347-8041

Other practice location 2

6010 Highway 707 Ste 300
Myrtle Beach, SC 29588-7321
Phone (843) 347-8041

Other identifiers

IdentifierTypeStateIssuer
8123PAMedicaidSC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 4, 2025.

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1376908657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8004 MYRTLE TRACE DR STE 200",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 62nd Ave N",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295727202",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6010 Highway 707 Ste 300",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295887321",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "AMANDA",
        "middle_name": "BLANCHE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-30",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "5901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8123PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

All providers in Conway, SC · Surgical Physician Assistant in South Carolina

Sources for this page

Verify at the official NPI Registry.