Amanda Mitchell Waggoner, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110002368 Issued in VA

Practice address

207 Bulifants Blvd Ste C
Williamsburg, VA 23188-5732

Phone

(757) 622-6315

Fax

(757) 622-7022

NPI assigned

Oct 17, 2006

Last updated

Jun 24, 2024By the provider in NPPES

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 B Mitchell Former name

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Physician Assistant

Education

Eastern Virginia Medical School, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pariser Dermatology Specialists LTDGroup PAC ID 7113902925, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Williamsburg Regional Medical Center Hospital, Williamsburg, VA, CCN 490066

Merit-based Incentive Payment System (MIPS)

Final score

82.4 of 100Reported as group

Quality

78.82

Improvement activities

40

Cost

80.17

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: amandawaggoner@pdsltd.allscriptsdirect.net

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.

• Pariser Dermatology Specialists LTD

  • Dermatology Physician
  • Norfolk, VA
  • NPI 1417047952
  Medicare reassignment Care Compare group

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

• Sentara Hospitals

  dba Sentara Williamsburg Regional Medical Center

  • General Acute Care Hospital
  • Williamsburg, VA
  • NPI 1619938149
  Care Compare affiliation

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1477634582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 KEMPSVILLE CIR",
            "address_2": "SUITE 200 A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023933",
            "telephone_number": "757-622-6315",
            "fax_number": "757-625-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 BULIFANTS BLVD STE C",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885732",
            "telephone_number": "757-622-6315",
            "fax_number": "757-622-7022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11842 Rock Landing Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236064437",
            "country_code": "US",
            "telephone_number": "757-595-8816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "AMANDA",
        "middle_name": "MITCHELL",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "MITCHELL",
            "middle_name": "B",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lawrence R. Volz, M.D.
• Naomi Renee Voss, CPM
• Vpa PC (HarmonyCares Medical Group)
• Hasmukh A Vyas, M.B.,B.S.
• Stephen Waddell
• Amarish A Wagle, PT
• Jo-Ann Wagner, LCSW
• Dalia Wahba, DDS
• Katie Wahlstrom
• Wal-Mart Stores East LP (WalMart Pharmacy 10-5754)

• Physician Assistant in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.