Individual provider Active NPI

Amanda J Kulesza, P.A.

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1467844282
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116350 Issued in FL
Practice address
2776 Cleveland Ave
Fort Myers, FL 33901-5864
Phone
(239) 343-1614
Fax
(239) 343-3695
NPI assigned
Mar 3, 2015
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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 018357 NY
Physician Assistant 363A00000X PA9116350 FL Primary

Addresses

Primary practice location

2776 Cleveland Ave
Fort Myers, FL 33901-5864

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-1614

Other identifiers 1

IdentifierTypeStateIssuer
115538600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180117001758 NY Practitioner - Physician Assistant 8820357973 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2175 86TH St
Brooklyn, NY 11214-3205
Phone (646) 828-6401

2187 Richmond Ave
Staten Island, NY 10314-3920
Phone (646) 682-7364

2710 Hylan Blvd
Staten Island, NY 10306-4658
Phone (718) 489-3551

336 E 86TH St
New York, NY 10028-4615
Phone (212) 772-3627

8712 4TH Ave
Brooklyn, NY 11209-5110
Phone (718) 530-1155

Merit-based Incentive Payment System (MIPS)

Final score
86.33 of 100Reported as group
Quality
82.1
Promoting interoperability
100
Improvement activities
40
Cost
72.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018357NYMDOccupational Therapist
PA9116350FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Dec 4, 2017 Accepting new patients
New York University CurrentSince Dec 4, 2017 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Sep 30, 2019 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Sep 30, 2019 Accepting new patients

Locations

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Interoperability endpoints

  • Direct secure messaging: amanda.kulesza.1@2983.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1467844282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-1614",
            "fax_number": "239-343-3695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2776 CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339015864",
            "telephone_number": "239-343-1614",
            "fax_number": "239-343-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULESZA",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018357",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115538600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.