Sally Gantt Amaya, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1550 Issued in AL

Practice address

28490 2ND St Ste B
Daphne, AL 36526-7150

Phone

(251) 308-9800

NPI assigned

Apr 3, 2020

Last updated

Jan 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sally Hale Gantt Former name

Medicare fee-for-service enrollment

Enrolled in AL, FL2 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

Dynamic Pain and Wellness LLCGroup PAC ID 8527364058, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sally.gantt@2498.securemail.prognocis.com

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.

• Dynamic Pain & Wellness LLC

  • Anesthesiology Physician
  • Fort Walton Beach, FL
  • NPI 1285007989

  AL

  Medicare reassignment Care Compare group NPD
• Dynamic Pain & Wellness LLC

  • Pain Medicine (Anesthesiology) Physician
  • Dothan, AL
  • NPI 1588288641
  NPD
• Anesthesia Health Consultants

  • Certified Registered Nurse Anesthetist
  • Jeffersonville, IN
  • NPI 1336528926
  NPD

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1568091379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7418",
            "city": "SPANISH FORT",
            "state": "AL",
            "postal_code": "365777418",
            "telephone_number": "251-895-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28490 2ND ST STE B",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365267150",
            "telephone_number": "251-308-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMAYA",
        "first_name": "SALLY",
        "middle_name": "GANTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-03",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA1550",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "1550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "GANTT",
            "middle_name": "HALE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Daphne, AL
• Providers in Daphne, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.