Individual provider Active NPI

Amanda Dyan Zilka, PA

  • Physician Assistant
  • Southgate, MI
National Provider Identifier
1588976013
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005727 Issued in MI
Practice address
15450 Northline Rd
Ste 101
Southgate, MI 48195-2398
Phone
(734) 282-2020
Fax
(734) 282-2002
NPI assigned
Jul 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005727 MI Primary

Addresses

Primary practice location

15450 Northline Rd
Ste 101
Southgate, MI 48195-2398

Mailing address

1640 Fort St
Suite D Attn Denise
Trenton, MI 48183-2040
Phone (734) 391-3057

Other identifiers 2

IdentifierTypeStateIssuer
1710315932OtherGROUP NPI HENRY FORD WYANDOTTE
0H28864OtherMIBLUE CROSS

Other names 1

  • Amanda Dyan Atterberry Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20130415000179 MI Practitioner - Physician Assistant 7315183563 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Wyandotte HospitalGroup PAC ID 2264334499, shared by 9 NPIs, 194 clinicians

Practice addresses (Care Compare)

2070 Biddle Ave
Suite 2
Wyandotte, MI 48192-4080

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005727MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Wyandotte Hospital CurrentSince Feb 23, 2015 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Feb 23, 2015 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Mar 15, 2015 Accepting new patients
Henry Ford Wyandotte Hospital Physician Assistant Past Accepting new patients
Henry Ford Wyandotte Hospital Past Accepting new patients

Locations

7226 Allen Rd
Allen Park, MI 48101
Phone (313) 383-5530

15450 Northline Rd
Ste 101
Southgate, MI 48195
Phone (734) 225-1315

1640 Fort St
Ste D
Trenton, MI 48183
Phone (734) 391-3057

2070 Biddle Ave
Ste 200
Wyandotte, MI 48192
Phone (734) 225-9100

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

Interoperability endpoints

  • Direct secure messaging: azilka57193@direct.hfhs.org

Organizations & group practices 7

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": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1588976013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 FORT ST",
            "address_2": "SUITE D ATTN DENISE",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481832040",
            "telephone_number": "734-391-3057",
            "fax_number": "734-391-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 NORTHLINE RD",
            "address_2": "STE 101",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952398",
            "telephone_number": "734-282-2020",
            "fax_number": "734-282-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZILKA",
        "first_name": "AMANDA",
        "middle_name": "DYAN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-13",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI HENRY FORD WYANDOTTE",
            "identifier": "1710315932",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0H28864",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ATTERBERRY",
            "middle_name": "DYAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Southgate, MI

Sources for this page

Verify at the official NPI Registry.