Individual provider Active NPI

Amanda Lee Trevino, FNP

  • Family Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1710450762
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2018044128 Issued in MO
Practice address
1540 E Evergreen St
Springfield, MO 65803-4300
Phone
(417) 823-2900
Fax
(417) 886-2774
NPI assigned
Jan 2, 2019
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2018044128 MO Primary

Addresses

Primary practice location

1540 E Evergreen St
Springfield, MO 65803-4300

Mailing address

3183 E Liberty St
Republic, MO 65738-7826
Phone (417) 755-6486

Other practice location 1

101 S Main St
Rogersville, MO 65742-9357
Phone (417) 753-9404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190409000301 MO Practitioner - Nurse Practitioner 9032450614 Reassigns benefits to 1 organization
I20200620000005 SC Practitioner - Nurse Practitioner 9032450614

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
Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

1540 E Evergreen St
Springfield, MO 65803-4300
Phone (417) 823-2900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22831SCMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sgoh Acquisition Inc CurrentSince Aug 21, 2024 Accepting new patients
Primrose Nephrology, Inc. Current Accepting new patients
Elite Pain Management, LLC CurrentSince Jun 15, 2020 Accepting new patients
Sgoh Acquisition Inc CurrentSince Aug 21, 2024 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221

106 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

101 S Main St
Rogersville, MO 65742
Phone (417) 753-9404

1540 E Evergreen St
Springfield, MO 65803
Phone (417) 823-2900

222 E Primrose St
Ste E
Springfield, MO 65807
Phone (417) 553-1080

4237 River Hills Dr
Ste 170
Little River, SC 29566
Phone (843) 273-0376

8212 Devon Ct
Myrtle Beach, SC 29572
Phone (843) 273-0379

Interoperability endpoints

  • Direct secure messaging: elitepainmanagement.amandatrevino@133100.advancedmd-direct.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.

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": "1546387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1710450762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3183 E LIBERTY ST",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657387826",
            "telephone_number": "417-755-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 E EVERGREEN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034300",
            "telephone_number": "417-823-2900",
            "fax_number": "417-886-2774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 S Main St",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "MO",
            "postal_code": "657429357",
            "country_code": "US",
            "telephone_number": "417-753-9404",
            "fax_number": "417-753-9137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TREVINO",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-02",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018044128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.