Individual provider Active NPI

Amanda Rae Whiteside, PA-C

  • Surgical Physician Assistant
  • Sun City West, AZ
National Provider Identifier
1396210621
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
7530 Issued in AZ
Practice address
14520 W Granite Valley Dr Ste 210
Sun City West, AZ 85375-5855
Phone
(866) 974-2673
Fax
(866) 939-2673
NPI assigned
Oct 13, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7530 AZ
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X 7530 AZ Primary

Addresses

Primary practice location

14520 W Granite Valley Dr Ste 210
Sun City West, AZ 85375-5855

Mailing address

18444 N 25TH Ave Ste 310
Phoenix, AZ 85023-1266
Phone (669) 742-6738

Other practice location 1

10484 W Thunderbird Blvd Ste 100
Sun City, AZ 85351-6019
Phone (866) 974-2673

Other practice location 2

18444 N 25th Ave Ste 210
Phoenix, AZ 85023-1264
Phone (866) 974-2673

Other identifiers 1

IdentifierTypeStateIssuer
583027MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20191022003907 AZ Practitioner - Physician Assistant 8426380544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
At Still University, Arizona School of Dentistry & Oral HLTH, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10494 W Thunderbird Blvd
Sun City, AZ 85351-6122
Phone (866) 974-2673

14520 W Granite Valley Dr
Sun City West, AZ 85375-5855

18444 N 25TH Ave
Phoenix, AZ 85023-1264
Phone (866) 974-2673

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.65 of 100Reported as group
Quality
76.23
Promoting interoperability
100
Improvement activities
40
Cost
75.95

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7530AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Orthopedic Research and Education, LLC Physician Assistant CurrentSince Oct 1, 2019 Accepting new patients

Locations

3420 S Mercy Rd
Ste 200
Gilbert, AZ 85297
Phone (480) 909-3788

2680 S Val Vista Dr
Ste 146
Gilbert, AZ 85295
Phone (480) 454-7680

1450 S Dobson Rd
Ste B122
Mesa, AZ 85202
Phone (480) 580-2001

1500 S Dobson Rd
Ste 202
Mesa, AZ 85202
Phone (866) 974-2676

9321 W Thomas Rd
Ste 205
Phoenix, AZ 85037

18444 N 25th Ave
Ste 310
Phoenix, AZ 85023
Phone (623) 241-8706

18444 N 25th Ave
Ste 210
Phoenix, AZ 85023
Phone (669) 742-6738

8952 E Desert Cove Ave
Ste 113
Scottsdale, AZ 85260
Phone (480) 314-7772

10494 W Thunderbird Blvd
Ste 102
Sun City, AZ 85351
Phone (623) 975-8311

10484 W Thunderbird Blvd
Ste 100
Sun City, AZ 85351
Phone (669) 742-6738

10503 W Thunderbird Blvd
Ste 262
Sun City, AZ 85351
Phone (623) 832-5589

13995 W Statler Blvd
Ste 165
Surprise, AZ 85374
Phone (623) 537-5661

Interoperability endpoints

  • Direct secure messaging: amanda.whiteside.1@22724.direct.athenahealth.com

Organizations & group practices 1

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": "1539388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1396210621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18444 N 25TH AVE STE 310",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850231266",
            "telephone_number": "669-742-6738",
            "fax_number": "866-939-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14520 W GRANITE VALLEY DR STE 210",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853755855",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10484 W Thunderbird Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853516019",
            "country_code": "US",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18444 N 25th Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850231264",
            "country_code": "US",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITESIDE",
        "first_name": "AMANDA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-13",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7530",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "7530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "583027",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City West, AZ

Sources for this page

Verify at the official NPI Registry.