Individual provider Active NPI

Amanda Hannah, PA-C

  • Physician Assistant
  • Marietta, OH
National Provider Identifier
1588031355
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.005022RX Issued in OH
Practice address
401 Matthew St
Marietta, OH 45750-1635
Phone
(740) 376-1994
Fax
(740) 374-7701
NPI assigned
Aug 28, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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 10001898A IN
Physician Assistant 363A00000X 50.005022RX OH Primary

Addresses

Primary practice location

401 Matthew St
Marietta, OH 45750-1635

Mailing address

401 Matthew St
Marietta, OH 45750-1635
Phone (740) 374-7700

Other practice location 1

1106 Colegate Dr
Marietta, OH 45750-1323
Phone (740) 374-7700

Other names 1

  • Amanda Ealing Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hospital.provider@mmhs.medicity.net
Direct Messaging Address hospital.provider@mmhs.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20170411001786 OH Practitioner - Physician Assistant 1153631395 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marietta Memorial HospitalGroup PAC ID 8224928965, 387 clinicians

Practice addresses (Care Compare)

1106 Colegate Dr
Marietta, OH 45750-1323
Phone (740) 568-2000

401 Matthew St
Marietta, OH 45750-1635
Phone (740) 374-1400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.005022RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Selby General Hospital CurrentSince Jan 1, 2026 Accepting new patients
Selby General Hospital CurrentSince Jan 1, 2026 Accepting new patients
Marietta Memorial Hospital Past Accepting new patients

Locations

401 Matthew St
Marietta, OH 45750
Phone (740) 374-1400

416 Colegate Dr
#3
Marietta, OH 45750
Phone (740) 236-9047

1106 Colegate Dr
Marietta, OH 45750
Phone (740) 374-7700

Organizations & group practices 4

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 1

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": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1588031355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MATTHEW ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501635",
            "telephone_number": "740-374-7700",
            "fax_number": "740-374-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MATTHEW ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501635",
            "telephone_number": "740-376-1994",
            "fax_number": "740-374-7701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 Colegate Dr",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "OH",
            "postal_code": "457501323",
            "country_code": "US",
            "telephone_number": "740-374-7700",
            "fax_number": "740-374-7701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNAH",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-28",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10001898A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005022RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hospital.provider@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "401 Matthew St",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hospital.provider@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "1106 Colegate Dr",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "EALING",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marietta, OH

Sources for this page

Verify at the official NPI Registry.