Individual provider Active NPI

Amanda J. Burrell

  • Medical Physician Assistant
  • Encinitas, CA
National Provider Identifier
1548884398
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
58867 Issued in CA
Practice address
477 N El Camino Real Ste A100
Encinitas, CA 92024-1329
Phone
(760) 943-9111
NPI assigned
Jun 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 58867 CA Primary
Physician Assistant 363A00000X 58867 CA

Addresses

Primary practice location

477 N El Camino Real Ste A100
Encinitas, CA 92024-1329

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (760) 479-3900

Other practice location 1

477 N El Camino Real Ste B303
Encinitas, CA 92024-1331
Phone (760) 479-3900

Other names 1

  • Amanda J. Durham Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210827001341 CA Practitioner - Physician Assistant 3678978756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58867CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Physician Assistant CurrentSince Sep 20, 2021 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Sep 20, 2021 Accepting new patients
Scripps Health Past Accepting new patients

Locations

477 N El Camino Real
Ste A100
Encinitas, CA 92024
Phone (760) 310-0045

477 N El Camino Real
Ste B303
Encinitas, CA 92024
Phone (760) 479-3900

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1591488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1548884398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "760-479-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 N EL CAMINO REAL STE A100",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920241329",
            "telephone_number": "760-943-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "477 N El Camino Real Ste B303",
            "address_purpose": "LOCATION",
            "city": "Encinitas",
            "state": "CA",
            "postal_code": "920241331",
            "country_code": "US",
            "telephone_number": "760-479-3900",
            "fax_number": "760-634-4845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURRELL",
        "first_name": "AMANDA",
        "middle_name": "J.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-07",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "58867",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "DURHAM",
            "middle_name": "J.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Encinitas, CA

Sources for this page

Verify at the official NPI Registry.