Active NPI
Amanda Danielson Brodie, PA
- Physician Assistant
- Greenville, SC
National Provider Identifier
1619251519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1693
- Practice address
- 9 Hawthorne Park CT
Greenville, SC 29615 - Phone
- (864) 603-5600
- Fax
- (864) 603-5601
- NPI assigned
- Oct 11, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1693 | SC | Primary |
Addresses
Primary practice location
9 Hawthorne Park CT
Greenville, SC 29615
Mailing address
525 Verdae Blvd
Suite 200
Greenville, SC 29607-4021
Phone (864) 603-5600
Other practice location 1
201 N. Main Street
Greenville, SC 29601
Phone (864) 603-5600
Other practice location 2
312 Harrison Bridge Rd
Simpsonville, SC 29680
Phone (864) 603-5600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1274PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111129000453 | SC | Practitioner - Physician Assistant | 7113191248 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528934400000",
"number": "1619251519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 VERDAE BLVD",
"address_2": "SUITE 200",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296074021",
"telephone_number": "864-603-5600",
"fax_number": "864-603-5601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 HAWTHORNE PARK CT",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "29615",
"telephone_number": "864-603-5600",
"fax_number": "864-603-5601"
}
],
"practiceLocations": [
{
"address_1": "201 N. Main Street",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "SC",
"postal_code": "29601",
"country_code": "US",
"telephone_number": "864-603-5600",
"fax_number": "864-603-5601",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "312 HARRISON BRIDGE RD",
"address_purpose": "LOCATION",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "29680",
"country_code": "US",
"telephone_number": "864-603-5600",
"fax_number": "864-603-5601",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRODIE",
"first_name": "AMANDA",
"middle_name": "DANIELSON",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-11",
"last_updated": "2018-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "1693",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1274PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.