Individual provider Active NPI

Amanda Baird Street

  • Nurse Practitioner
  • Haymarket, VA
National Provider Identifier
1649767773
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024176366 Issued in VA
Practice address
15195 Heathcote Blvd
Haymarket, VA 20169-6242
Phone
(571) 261-3529
Fax
(703) 361-1811
NPI assigned
Apr 14, 2018
Last updated
Feb 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024176366 NC
Nurse Practitioner 363L00000X 0024176366 VA Primary

Addresses

Primary practice location

15195 Heathcote Blvd
Haymarket, VA 20169-6242

Mailing address

PO Box 748613
Atlanta, GA 30384-8613

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address astreet679438@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20181214001818 VA Practitioner - Nurse Practitioner 7315282662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15195 Heathcote Blvd
Suite 320
Haymarket, VA 20169-6244
Phone (571) 261-3529

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024176366NCMDNurse Practitioner
0024176366VAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Uva Community Health Medical Group, LLC CurrentSince Nov 12, 2018 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Nov 12, 2018 Accepting new patients
Uva Community Health Medical Group, LLC Past Accepting new patients

Locations

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

7915 Lake Manassas Dr
Ste 205
Gainesville, VA 20155
Phone (571) 261-3529

15195 Heathcote Blvd
Ste 320
Haymarket, VA 20169
Phone (571) 261-3529

8691 Stonewall Rd
Ste 118
Manassas, VA 20110

Organizations & group practices 3

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.

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": "1523664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1649767773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15195 HEATHCOTE BLVD",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201696242",
            "telephone_number": "571-261-3529",
            "fax_number": "703-361-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "AMANDA",
        "middle_name": "BAIRD",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-14",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "0024176366",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024176366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "astreet679438@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "15195 Heathcote Blvd",
            "city": "Haymarket",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201696242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Haymarket, VA

Sources for this page

Verify at the official NPI Registry.