Individual provider Active NPI

Amanda Lynn Coleman, PA-C

  • Physician Assistant
  • Idaho Falls, ID
National Provider Identifier
1649864414
Registry record updated Oct 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1972 Issued in ID
Practice address
2680 Channing Way
Idaho Falls, ID 83404-7517
Phone
(208) 523-7667
Fax
(208) 523-7668
NPI assigned
Feb 23, 2021
Last updated
Oct 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2023

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 PA-1972 ID Primary

Addresses

Primary practice location

2680 Channing Way
Idaho Falls, ID 83404-7517

Mailing address

2680 Channing Way
Idaho Falls, ID 83404-7517
Phone (208) 523-7667

Other practice location 1

60 W Main St
Rexburg, ID 83440-1825
Phone (208) 716-8723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20220420001479 ID Practitioner - Physician Assistant 0143617282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2305 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-1764

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

2330 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2351 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-7310

2353 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-4823

2375 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2610 Channing Way
Idaho Falls, ID 83404-7517
Phone (208) 523-2928

2680 Channing Way
Idaho Falls, ID 83404-7517
Phone (208) 523-7668

404 N 2ND
Rexburg, ID 83440-1608
Phone (208) 359-1770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-1972IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Nov 1, 2021 Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients

Locations

1443 Parkway Dr
Ste 4
Blackfoot, ID 83221
Phone (208) 523-7667

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2680 Channing Way
Idaho Falls, ID 83404
Phone (208) 522-4026

404 N 2nd E
Rexburg, ID 83440
Phone (208) 359-1770

Organizations & group practices 2

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 4

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": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698537600000",
    "number": "1649864414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047517",
            "telephone_number": "208-523-7667",
            "fax_number": "208-523-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047517",
            "telephone_number": "208-523-7667",
            "fax_number": "208-523-7668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 W Main St",
            "address_purpose": "LOCATION",
            "city": "Rexburg",
            "state": "ID",
            "postal_code": "834401825",
            "country_code": "US",
            "telephone_number": "208-716-8723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-23",
        "last_updated": "2023-10-29",
        "certification_date": "2023-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.