NPIMap

Individual provider Active NPI

Amanda Grace Kiessel, PA-C

  • Physician Assistant
  • Durango, CO
National Provider Identifier
1669929063
Registry record updated Feb 23, 2022
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0005179 Issued in CO
Practice address
2577 Main Ave
Durango, CO 81301-5919
Phone
(970) 247-8382
Fax
(970) 259-4403
NPI assigned
Sep 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2017-0102 NM
Physician Assistant 363A00000X 6501 AZ
Physician Assistant 363A00000X PA.0005179 CO Primary

Addresses

Primary practice location

2577 Main Ave
Durango, CO 81301-5919

Mailing address

2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382

Other practice location 1

1010 Three Springs Blvd
Durango, CO 81301-8296
Phone (970) 247-4300

Other practice location 2

604 S Rio Grande Ave
Aztec, NM 87410-2260
Phone (505) 334-2664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, NM2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190219002308 CO Practitioner - Physician Assistant 8325328370 Reassigns benefits to 2 organizations
I20220303002320 NM Practitioner - Physician Assistant 8325328370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Durango Urgent Care LLCGroup PAC ID 9335141266, 18 clinicians
Aztec Urgent Care, LLCGroup PAC ID 7810189016, 17 clinicians

Practice addresses (Care Compare)

1942 E Main St
Cortez, CO 81321-3039
Phone (970) 516-5500

2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382

2930 E Main St
Farmington, NM 87402-7624
Phone (970) 505-2100

Hospital & facility affiliations

  • Mercy Regional Medical Center Hospital, Durango, CO, CCN 060013

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as group
Quality
91.15
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6501AZMDDermatology Physician
PA.0005179COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs of Colorado Inc Emergency Medicine CurrentSince Jan 24, 2019 Accepting new patients
Usacs of Colorado Inc Emergency Medicine CurrentSince Jan 24, 2019 Accepting new patients

Locations

1010 Three Springs Blvd
Durango, CO 81301
Phone (970) 247-4311

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

2551 W 84th Ave
Westminster, CO 80031
Phone (303) 202-1280

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 and National Provider Directory roles.

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": "1472774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1669929063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2577 MAIN AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015919",
            "telephone_number": "970-247-8382",
            "fax_number": "970-259-4403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2577 MAIN AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015919",
            "telephone_number": "970-247-8382",
            "fax_number": "970-259-4403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Three Springs Blvd",
            "address_purpose": "LOCATION",
            "city": "Durango",
            "state": "CO",
            "postal_code": "813018296",
            "country_code": "US",
            "telephone_number": "970-247-4300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "604 S Rio Grande Ave",
            "address_purpose": "LOCATION",
            "city": "Aztec",
            "state": "NM",
            "postal_code": "874102260",
            "country_code": "US",
            "telephone_number": "505-334-2664",
            "fax_number": "505-334-7759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIESSEL",
        "first_name": "AMANDA",
        "middle_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-02",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2017-0102",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6501",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.