Amanda Marie Staley

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95011691 Issued in CA

Practice address

11175 Campus St Ste 11120
Loma Linda, CA 92350-1700

Phone

(909) 558-8291

NPI assigned

Nov 25, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: astaley279416@direct.llu.edu

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.

• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment NPD
• Performance Health Medical Group, Inc

  • Family Medicine Physician
  • Laguna Hills, CA
  • NPI 1093896862
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Anatomic Pathology Physician
  • Murrieta, CA
  • NPI 1588020432
  NPD

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1740826601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS ST STE 11120",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923501700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS ST STE 11120",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923501700",
            "telephone_number": "909-558-8291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95011691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Ssembajjwe
• Paul St John Hammond, MB BS DPHIL
• Andrew McVeigh Stacy, DO
• Richard Dale Staggs, NURSE PRACTITIONER
• Jake Stahnke, DO
• Veda Stalling
• Alexi Noelle Stamatis
• Joshua James Stanfield, RN
• Ben Stanowski, HA4010
• Thomas Macke Stansbury, LCSW

• Family Nurse Practitioner in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.