Individual provider Active NPI

Amanda L Rosen

  • Family Nurse Practitioner
  • Clayton, NY
National Provider Identifier
1508535337
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
348027 Issued in NY
Practice address
909 Strawberry LN
Clayton, NY 13624-1409
Phone
(315) 686-2094
NPI assigned
Sep 7, 2021
Last updated
Dec 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 348027 NY Primary

Addresses

Primary practice location

909 Strawberry LN
Clayton, NY 13624-1409

Mailing address

909 Strawberry LN
Clayton, NY 13624-1409
Phone (315) 686-2094

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
I20220125001259 NY Practitioner - Nurse Practitioner 9739571704 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 CenterGroup PAC ID 8123914876, 157 clinicians

Practice addresses (Care Compare)

909 Strawberry LN
Clayton, NY 13624-1409
Phone (315) 656-2094

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
348027NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Keep Nursing Home Inc CurrentSince Apr 17, 2023 Accepting new patients

Locations

133 Pratt St
Watertown, NY 13601
Phone (315) 785-4400

Interoperability endpoints

  • Direct secure messaging: amanda.rosen@sfhcny.eclinicaldirectplus.com

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, NY

Sources for this page

Verify at the official NPI Registry.