NPIMap

Individual provider Active NPI

Amanda Simmons Grace, MD

  • Emergency Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1396773628
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
33644 Issued in AZ
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1200
Fax
(602) 263-1619
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 33644 AZ Primary
Family Medicine Physician 207Q00000X 33644 AZ

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

PO Box 95460
Cleveland, OH 44101-0033
Phone (602) 581-6076

Other identifiers 2

IdentifierTypeStateIssuer
P00477582OtherAZRR MEDICARE
989759MedicaidAZ

Other names 1

  • Amanda Simmons Lake Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051220000033 AZ Practitioner - Emergency Medicine 1153343116 Reassigns benefits to 2 organizations
I20251201000803 TX Practitioner - Emergency Medicine 1153343116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Empower St Josephs PLLCGroup PAC ID 2961866173, 52 clinicians
Tec Emergency Physicians of Arizona, LLCGroup PAC ID 6204256084, 155 clinicians

Practice addresses (Care Compare)

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-3000

4212 N 16TH St
Phoenix, AZ 85016-5319
Phone (602) 263-1200

7171 S 51St Ave
Laveen, AZ 85339-2923
Phone (888) 732-3317

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33644AZMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Oct 14, 2025 Accepting new patients
Tec Emergency Physicians of Arizona, LLC CurrentSince Sep 3, 2022 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Oct 14, 2025 Accepting new patients
Empower St Josephs PLLC Emergency Medicine CurrentSince Jan 9, 2024 Accepting new patients
Shea Urgent Care LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients
Greenway Urgent Care LLC Past Accepting new patients
Glendale Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients

Locations

7300 N 99th Ave
Glendale, AZ 85307
Phone (480) 339-5001

7171 S 51st Ave
Laveen, AZ 85339
Phone (623) 584-5100

9130 E Elliot Rd
Mesa, AZ 85212
Phone (480) 410-4500

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

1419 W Hunt Hwy
San Tan Vly, AZ 85143
Phone (480) 245-4300

14818 N 74th St
Scottsdale, AZ 85260
Phone (480) 339-5088

5125 S Rural Rd
Tempe, AZ 85282
Phone (480) 306-8780

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1396773628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95460",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441010033",
            "telephone_number": "602-581-6076",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACE",
        "first_name": "AMANDA",
        "middle_name": "SIMMONS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "33644",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "33644",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00477582",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "989759",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LAKE",
            "middle_name": "SIMMONS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.