Amanda Sue Poulos, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00931200 Issued in NJ

Practice address

1412 Fairmount Ave
Philadelphia, PA 19130-2908

Phone

(215) 235-9600

Fax

(215) 684-5360

NPI assigned

Oct 23, 2017

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 Davis Former name

Medicare fee-for-service enrollment

Enrolled in PA, NJ2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cooper Faculty OB-GYN, PCGroup PAC ID 9931090214, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cooper University Hospital Hospital, Camden, NJ, CCN 310014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: apoulos320882@direct.cooperhealth.edu
• Direct secure messaging: amanda.davis.p1@direct.dvch.nextgenshare.com

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.

• Cooper Faculty OB-GYN, PC

  • Obstetrics & Gynecology Physician
  • Cherry Hill, NJ
  • NPI 1225058027
  Medicare reassignment Care Compare group
• Delaware Valley Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1386864502
  Medicare reassignment NPD
• Cooper Obstetrical Associates, PC

  • Obstetrics & Gynecology Physician
  • Camden, NJ
  • NPI 1194745976
  Medicare reassignment
• Delaware Valley Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1235956921
  NPD
• University Urogynecology Association, PC

  • Obstetrics & Gynecology Physician
  • Voorhees, NJ
  • NPI 1255352423
  NPD (past)

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

• The Cooper Health System

  • Land Ambulance
  • Camden, NJ
  • NPI 1174976724

  Hospital

  Care Compare affiliation
• The Cooper Health System

  • General Acute Care Hospital
  • Camden, NJ
  • NPI 1568442309
  Care Compare affiliation

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1508377060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST STE 200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031088",
            "telephone_number": "848-288-6935",
            "fax_number": "732-790-0107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 FAIRMOUNT AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-235-9600",
            "fax_number": "215-684-5360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Cooper Plz Rm 300",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081031438",
            "country_code": "US",
            "telephone_number": "856-342-2959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "AMANDA",
        "middle_name": "SUE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-23",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00931200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "DAVIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua Potts
• Marilyn R Potts, M.ED.
• Elizabeth Poturalski
• Jonathan Pou
• Valeriya Poukas, M.D.
• Ryan Andrew Poulsen, LGSW
• Claire L Pouncey, MD
• Payam Pourhassani, D.O.
• Seyedmohammad Pourshahid
• Alina Julia Poust

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; 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.