Amanda Lynn Agley, PA-C

Key facts

NPI

1730748419

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

023549 (NY)

Practice address

830 Washington St
Watertown, NY 13601-4034

Phone

(315) 755-3670

Fax

(315) 755-3671

NPI assigned

Jun 6, 2019

Sex

Female

Sole proprietor

No

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 and National Provider Directory roles.

• Samaritan Medical Center General Acute Care Hospital · Watertown, NY · NPI 1598713745
  Medicare reassignment Care Compare group NPD NY
• Samaritan Medical Center Rehabilitation Hospital Unit · Watertown, NY · NPI 1093722068
  Care Compare group NPD
• Canton-Potsdam Hospital General Acute Care Hospital · Potsdam, NY · NPI 1568548782
  Medicare reassignment NY
• Samaritan Medical Center Community/Retail Pharmacy · Watertown, NY · NPI 1447051305
  Care Compare group
• Canton-Potsdam Hospital Medicare Defined Swing Bed Hospital Unit · Potsdam, NY · NPI 1114104445
  NPD
• Eye Care for the Adirondacks Associates in Ophthalmology, PC Eyewear Supplier · Plattsburgh, NY · NPI 1578777199
  NPD (past)

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Samaritan Medical Center General Acute Care Hospital · Watertown, NY · NPI 1598713745
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Medical Center (157 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Samaritan Medical Center Hospital · Watertown, NY · CCN 330157

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.agley@sfhcny.eclinicaldirectplus.com

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 15, 2024.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1730748419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-755-3670",
            "fax_number": "315-755-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-755-3670",
            "fax_number": "315-755-3671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10881 US Route 11",
            "address_purpose": "LOCATION",
            "city": "Adams",
            "state": "NY",
            "postal_code": "136053154",
            "country_code": "US",
            "telephone_number": "315-755-3670",
            "fax_number": "315-755-3671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGLEY",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05967193",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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