NPIMap

Individual provider Active NPI

Amanda Burks

  • Physician Assistant
  • Moscow, ID
National Provider Identifier
1699305185
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2583 Issued in ID
Practice address
803 S Main St Ste 120
Moscow, ID 83843-2695
Phone
(208) 848-8300
NPI assigned
Jan 23, 2020
Last updated
Oct 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA61038299 WA
Physician Assistant 363A00000X PA-2583 ID Primary

Addresses

Primary practice location

803 S Main St Ste 120
Moscow, ID 83843-2695

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 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
I20200407002550 WA Practitioner - Physician Assistant 7810326154 Reassigns benefits to 1 organization
I20231012000880 ID Practitioner - Physician Assistant 7810326154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1203 Idaho St
Lewiston, ID 83501-1940
Phone (208) 848-8300

803 S Main St
Moscow, ID 83843-2695
Phone (208) 848-8300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA61038299WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Nov 7, 2023 Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Apr 1, 2020 Accepting new patients
Community Health Association of Spokane CurrentSince Nov 7, 2023 Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Apr 1, 2020 Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Locations

803 S Main St
Ste 120
Moscow, ID 83843
Phone (208) 848-8300

713 Memorial St
Prosser, WA 99350
Phone (509) 786-1931

611 N Iron Bridge Way
Spokane, WA 99202

1120 W Rose St
Walla Walla, WA 99362
Phone (509) 525-6650

Interoperability endpoints

  • Direct secure messaging: aelkhatib33609@yvfwc.direct-ci.com
  • Direct secure messaging: amanda.burks.1@11411.direct.athenahealth.com

Organizations & group practices 6

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 3

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": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1699305185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST STE 120",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432695",
            "telephone_number": "208-848-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKS",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61038299",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.