Individual provider Active NPI

Amanda Irene Diffin, PA-C

  • Physician Assistant
  • Leominster, MA
National Provider Identifier
1710547385
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7139 Issued in MA
Practice address
100 Hospital Rd Ste 4
Leominster, MA 01453-2253
Phone
(978) 514-6300
NPI assigned
Jun 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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 PA7139 MA Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

100 Hospital Rd Ste 4
Leominster, MA 01453-2253

Mailing address

87 N Main St
Leominster, MA 01453-5507
Phone (978) 534-8701

Other practice location 1

87 N Main St
Leominster, MA 01453-5507
Phone (978) 534-8701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20191104002595 MA Practitioner - Physician Assistant 6800128240 Reassigns benefits to 2 organizations

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
Pend Oreille County Public Hospital District No 1Group PAC ID 3274431184, shared by 5 NPIs, 31 clinicians
Family Medical and Maternity Care PCGroup PAC ID 6901840859, 14 clinicians

Practice addresses (Care Compare)

714 W Pine St
Newport, WA 99156-9046
Phone (509) 447-2441

87 N Main St
Leominster, MA 01453-5507
Phone (978) 534-8701

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates Pediatrics, P.C. CurrentSince Mar 4, 2021 Accepting new patients

Locations

100 Hospital Rd
Ste 4
Leominster, MA 01453
Phone (978) 514-6300

Organizations & group practices 3

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 2

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1710547385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 N MAIN ST",
            "city": "LEOMINSTER",
            "state": "MA",
            "postal_code": "014535507",
            "telephone_number": "978-534-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD STE 4",
            "city": "LEOMINSTER",
            "state": "MA",
            "postal_code": "014532253",
            "telephone_number": "978-514-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "87 N Main St",
            "address_purpose": "LOCATION",
            "city": "Leominster",
            "state": "MA",
            "postal_code": "014535507",
            "country_code": "US",
            "telephone_number": "978-534-8701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIFFIN",
        "first_name": "AMANDA",
        "middle_name": "IRENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2024-06-27",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7139",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leominster, MA

Sources for this page

Verify at the official NPI Registry.