Amanda L Rosen
Individual provider Active NPI Family Nurse Practitioner · Clayton, NY
NPI 1508535337 · NPPES record last updated Dec 9, 2024
Key facts
- NPI
- 1508535337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 348027 (NY)
- Practice address
- 909 Strawberry LN
Clayton, NY 13624-1409 - Phone
- (315) 686-2094
- NPI assigned
- Sep 7, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Samaritan Medical Center
Practice addresses (Care Compare)
909 Strawberry LN
Clayton, NY 13624-1409
Phone (315) 656-2094
Hospital & facility affiliations
- Samaritan Home Health, Inc
- Jefferson Co Pub HLTH SVS Chha
- Samaritan Medical Center
- River Hospital Clinics
- Carthage Area Hospital, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220125001259 | NY | Practitioner - Nurse Practitioner | 9739571704 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Keep Nursing Home Inc | Current |
Accepting new patients |
Locations
133 Pratt St
Watertown, NY 13601
Phone (315) 785-4400
Interoperability endpoints
- amanda.rosen@sfhcny.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 348027 | NY | Yes |
Addresses
Primary practice location
909 Strawberry LN
Clayton, NY 13624-1409
Mailing address
909 Strawberry LN
Clayton, NY 13624-1409
Phone (315) 686-2094
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06903011 | Medicaid | NY |
NPI Registry JSON
{
"created_epoch": "1630972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733702400000",
"number": "1508535337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 STRAWBERRY LN",
"city": "CLAYTON",
"state": "NY",
"postal_code": "136241409",
"telephone_number": "315-686-2094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 STRAWBERRY LN",
"city": "CLAYTON",
"state": "NY",
"postal_code": "136241409",
"telephone_number": "315-686-2094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSEN",
"first_name": "AMANDA",
"middle_name": "L",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-07",
"last_updated": "2024-12-09",
"certification_date": "2024-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "348027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06903011",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clayton, NY
- Sonja Pierce
- Kalie Marie Price-Kellogg
- Samantha Reynolds
- Mitchell David Rick
- River Ease Psychotherapy Services
- Jack D Rush
- Nosheen Sandhu
- Beth Anne Solar
- Thousand Islands Central School Districtq
- Thousand Islands Emergency Rescue Service Inc
All providers in Clayton, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.