Individual provider Active NPI

Amanda Klein Fox, PA

  • Physician Assistant
  • Ann Arbor, MI
National Provider Identifier
1417157983
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005133 Issued in MI
Practice address
1500 East Medical Center Dr
B1 Floor Cancer Center Recp C
Ann Arbor, MI 48109-5912
Phone
(734) 647-8902
NPI assigned
Jul 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005133 MI Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

1500 East Medical Center Dr
B1 Floor Cancer Center Recp C
Ann Arbor, MI 48109-5912

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other names 1

  • Amanda Chmielewski Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20071130000366 MI Practitioner - Physician Assistant 9537258496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4000

1801 Briarwood Cir
Ann Arbor, MI 48108-3347
Phone (734) 539-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Jan 27, 2009 Accepting new patients
Regents of the University of Michigan Physician Assistant CurrentSince Jan 27, 2009 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Spc 5912
Ann Arbor, MI 48109
Phone (734) 647-8902

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

1500 E Medical Center Dr
Fl Cancer
Ann Arbor, MI 48109
Phone (734) 647-8902

3621 S State St
#700
Ann Arbor, MI 48108

1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

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.

Hospital & facility affiliations 1

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": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1417157983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "B1 FLOOR CANCER CENTER RECP C",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095912",
            "telephone_number": "734-647-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "AMANDA",
        "middle_name": "KLEIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005133",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "CHMIELEWSKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.