Individual provider Active NPI

Amy Sarah Phillips, SLP

  • Speech-Language Pathologist
  • Kenmore, NY
National Provider Identifier
1730561986
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
58023952 Issued in NY
Practice address
2900 Delaware Ave
Kenmore, NY 14217-2309
Phone
(716) 871-9883
Fax
(716) 871-9887
NPI assigned
Jun 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 58023952 NY Primary

Addresses

Primary practice location

2900 Delaware Ave
Kenmore, NY 14217-2309

Mailing address

2900 Delaware Ave
Kenmore, NY 14217-2309
Phone (716) 871-9883

Other identifiers 2

IdentifierTypeStateIssuer
1447283882MedicaidNY
GROUP AA0040OtherNYMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231030000907 NY Practitioner - Qualified Speech Language Pathologist 2365898251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2900 Delaware Ave
Kenmore, NY 14217-2309
Phone (716) 871-9915

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023952NYMDPhysical Therapist
58023952NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Diversified Services for Occupational Therapy, Physical Ther Speech-Language Pathologist Current Accepting new patients
Diversified Services for Occupational Therapy, Physical Therapy, Speec CurrentSince Oct 30, 2023 Accepting new patients
Medical Practitioner Services of Wny PC Past Accepting new patients

Locations

2900 Delaware Ave
Kenmore, NY 14217
Phone (716) 262-9791

5883 Snyder Dr
Lockport, NY 14094
Phone (716) 433-8751

3670 S Benzing Rd
Ste G
Orchard Park, NY 14127

17 Limestone Dr
Ste 5
Williamsville, NY 14221
Phone (716) 362-1552

1780 Wehrle Dr
Ste 110
Williamsville, NY 14221
Phone (716) 362-1552

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.

NPI Registry JSON

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1730561986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883",
            "fax_number": "716-871-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883",
            "fax_number": "716-871-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "AMY",
        "middle_name": "SARAH",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "58023952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447283882",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "GROUP AA0040",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenmore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.