Amanda Jiddou Roosevelt, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

4301103232 Issued in MI

Practice address

5301 East Huron River
Anesthesia Department
Ypsilanti, MI 48197

Phone

(734) 712-3456

NPI assigned

May 13, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Holly Jiddou Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Wayne State University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
• St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002

Merit-based Incentive Payment System (MIPS)

Final score

67.5 of 100Reported as group

Quality

58.12

Improvement activities

40

Cost

68.45

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Anesthesia Associates of Ann Arbor, PLLC

  • Anesthesiology Physician
  • Westland, MI
  • NPI 1669581997
  Medicare reassignment Care Compare group NPD
• St Mary Mercy Hospital Crna

  • Certified Registered Nurse Anesthetist
  • Livonia, MI
  • NPI 1063602092

  Anesthesiology

  Medicare reassignment NPD

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

• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  Care Compare affiliation

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1437595816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 HOGBACK RD STE 5A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059750",
            "telephone_number": "734-263-2400",
            "fax_number": "734-773-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 EAST HURON RIVER",
            "address_2": "ANESTHESIA DEPARTMENT",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "48197",
            "telephone_number": "734-712-3456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 S Canton Center Rd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481881992",
            "country_code": "US",
            "telephone_number": "734-398-7557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7575 Grand River Rd",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481149309",
            "country_code": "US",
            "telephone_number": "810-844-7511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36475 Five Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481541971",
            "country_code": "US",
            "telephone_number": "734-655-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18101 Oakwood Blvd",
            "address_2": "Anesthesia Department",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "48124",
            "country_code": "US",
            "telephone_number": "313-436-2374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROOSEVELT",
        "first_name": "AMANDA",
        "middle_name": "JIDDOU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-13",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301103232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JIDDOU",
            "middle_name": "HOLLY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• George Roman, MD
• Ronald P. Adelman DPM PLLC
• Ailani Mae Rondez
• Cesar L Rondon-Fudinaga
• Maddie Rose Rood
• Ja'Nyah Roper
• Alayna Sherrylynn Roscoe
• Natalja Patricia Rosculet, MD
• Rose Rittinger, PLLC
• Diamond L Rosebur

• Anesthesiology Physician in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.