Individual provider Active NPI

Amanda C Adcock, PH.D.

  • Clinical Psychologist
  • Augusta, ME
National Provider Identifier
1740521855
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS1379 Issued in ME
Practice address
1 VA Ctr
Augusta, ME 04330-6719
Phone
(207) 623-8411
NPI assigned
Mar 14, 2013
Last updated
Mar 14, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS1379 ME Primary

Addresses

Primary practice location

1 VA Ctr
Augusta, ME 04330-6719

Mailing address

PO Box 63
Gardiner, ME 04345-0063

Other names 1

  • Dr. Amanda Adcock Vanderlugt Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240405000991 SD Practitioner - Clinical Psychologist 9638475262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4301 W 57TH St
Suite 100
Sioux Falls, SD 57108-2255
Phone (605) 335-1516

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS1379MEMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Starfish, LLC CurrentSince Jan 3, 2024 Accepting new patients

Locations

4301 W 57th St
Ste 100
Sioux Falls, SD 57108
Phone (605) 306-2228

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363219200000",
    "number": "1740521855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63",
            "city": "GARDINER",
            "state": "ME",
            "postal_code": "043450063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VA CTR",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306719",
            "telephone_number": "207-623-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADCOCK",
        "first_name": "AMANDA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-14",
        "last_updated": "2013-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "VANDERLUGT",
            "middle_name": "ADCOCK",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Augusta, ME

Sources for this page

Verify at the official NPI Registry.