Individual provider Active NPI

Amanda Raya Pardon, MD

  • Neurology Physician
  • Wilmington, NC
National Provider Identifier
1558598631
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
1044456 Issued in NC
Practice address
1509 Doctors Cir BLDG C
Wilmington, NC 28401-7403
Phone
(910) 662-7500
Fax
(910) 662-7501
NPI assigned
Jun 16, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurocritical Care Physician 2084A2900X ME124831 FL
Neurocritical Care Physician 2084A2900X NCC4114 NC
Neurology Physician 2084N0400X ME124831 FL
Neurology Physician 2084N0400X 1044456 NC Primary

Addresses

Primary practice location

1509 Doctors Cir BLDG C
Wilmington, NC 28401-7403

Mailing address

PO Box 936857
Atlanta, GA 31193-6857
Phone (910) 662-7500

Other practice location 1

800 Prudential Dr
Tower B 11TH Floor
Jacksonville, FL 32207-8202
Phone (904) 388-6518

Other identifiers 1

IdentifierTypeStateIssuer
015345500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220629001441 NC Practitioner - Neurology 7113161266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Washington University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1509 Doctors Cir
BLDG C
Wilmington, NC 28401-7403
Phone (910) 662-7550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
NCC4114NCMDNeurocritical Care Physician
1044456NCMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
NMG Health Services LLC CurrentSince May 6, 2022 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Neurology CurrentSince May 6, 2022 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients
Baptist Neurology Inc Neurology PastSince Sep 1, 2015 Accepting new patients

Locations

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1515 Doctors Cir
Bldg A
Wilmington, NC 28401

1509 Doctors Cir
Bldg C
Wilmington, NC 28401
Phone (910) 662-7550

Interoperability endpoints

  • Direct secure messaging: apardon1461192@direct.novanthealth.org

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 2

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": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1558598631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857",
            "telephone_number": "910-662-7500",
            "fax_number": "910-662-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 DOCTORS CIR BLDG C",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017403",
            "telephone_number": "910-662-7500",
            "fax_number": "910-662-7501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Prudential Dr",
            "address_2": "TOWER B 11TH FLOOR",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322078202",
            "country_code": "US",
            "telephone_number": "904-388-6518",
            "fax_number": "904-384-1005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARDON",
        "first_name": "AMANDA",
        "middle_name": "RAYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-16",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "FL",
            "license": "ME124831",
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "NC",
            "license": "NCC4114",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME124831",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "1044456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015345500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.