Individual provider Active NPI

Amanda Marie Romero, N.P

  • Pediatric Nurse Practitioner
  • San Carlos, CA
National Provider Identifier
1659748242
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
NP95002755 Issued in CA
Practice address
301 Industrial Rd
San Carlos, CA 94070-2603
Phone
(650) 321-4121
NPI assigned
Aug 31, 2015
Last updated
Jul 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NP95002755 CA Primary
Registered Nurse 163W00000X 824087 CA

Addresses

Primary practice location

301 Industrial Rd
San Carlos, CA 94070-2603

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 321-4121

Other practice location 1

2700 International Blvd
Suite 11
Oakland, CA 94601
Phone (510) 533-1248

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160627002571 CA Practitioner - Nurse Practitioner 8921399668 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

199 Churchill Ave
Woodside, CA 94062-1151
Phone (650) 573-2222

37 Clinton St
Redwood City, CA 94062-1595
Phone (650) 573-2222

400 Edmonds Rd
Redwood City, CA 94062-3803
Phone (650) 573-2222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP95002755CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Mateo CurrentSince Sep 10, 2016 Accepting new patients
County of San Mateo Current Accepting new patients
County of San Mateo CurrentSince Sep 10, 2016 Accepting new patients
County of San Mateo CurrentSince Sep 10, 2016 Accepting new patients
Roots Community Health Center Past Accepting new patients

Locations

2710 Middlefield Rd
Redwood City, CA 94063
Phone (650) 364-6010

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

Interoperability endpoints

  • Direct secure messaging: aromero18899@smch.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1659748242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-321-4121",
            "fax_number": "510-533-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 INDUSTRIAL RD",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940702603",
            "telephone_number": "650-321-4121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 International Blvd",
            "address_2": "Suite 11",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "94601",
            "country_code": "US",
            "telephone_number": "510-533-1248",
            "fax_number": "510-533-1870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROMERO",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "NP95002755",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "824087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Carlos, CA

Sources for this page

Verify at the official NPI Registry.