Amanda Green, PA-C
Individual provider Active NPI Physician Assistant · Shallotte, NC
NPI 1760083059 · NPPES record last updated Nov 17, 2025
Key facts
- NPI
- 1760083059
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0010-15310 (NC)
- Practice address
- 341 Whiteville Rd NW
Shallotte, NC 28470-4507 - Phone
- (877) 935-5255
- NPI assigned
- Nov 4, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 20
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tri County Community Health Council Inc
Practice addresses (Care Compare)
3331 Easy St
Dunn, NC 28334-7988
Phone (910) 567-6194
341 A Whiteville Rd NW
Shallotte, NC 28470-4507
Phone (910) 754-8731
4311 Old Ocean Hwy
Bolivia, NC 28422-8637
Phone (910) 567-6194
500 S Fayetteville St
Salemburg, NC 28385-8406
Phone (910) 525-5515
Hospital & facility affiliations
- Centracare - St. Cloud Hospital
- Centracare Health System - Melrose Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220408002096 | MN | Practitioner - Physician Assistant | 6204222771 | |
| I20260102002000 | NC | Practitioner - Physician Assistant | 6204222771 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-15310 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri County Community Health Council Inc | Current |
Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Tri County Community Health Council Inc | Current |
Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Tri County Community Health Council Inc | Past | Accepting new patients |
Locations
30 Railroad Ave
Albany, MN 56307
Phone (320) 845-2157
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
70 Crape Myrtle Dr
Ste 104
Benson, NC 27504
Phone (919) 938-0260
4311 Old Ocean Hwy
Bolivia, NC 28422
1480 Maple Grove Church Rd
Dunn, NC 28334
Phone (910) 567-5020
3331 Easy St
Dunn, NC 28334
194 Tomahawk Hwy
Harrells, NC 28444
Phone (910) 532-4106
507 N Brightleaf Blvd
Ste 209
Smithfield, NC 27577
Phone (919) 934-0850
5531 Eleanor Roosevelt Ln
Willard, NC 28478
Phone (910) 285-0400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-15310 | NC | Yes |
| Physician Assistant | 363A00000X | 14006 | MN |
Addresses
Primary practice location
341 Whiteville Rd NW
Shallotte, NC 28470-4507
Mailing address
30 Railroad Ave
Albany, MN 56307-9379
Phone (320) 845-2157
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14006 | Other | MN | MEDICAL LICENSE |
Other providers in Shallotte, NC
- Rebecca Sherrill Godbold
- Kathleen Mary Gomes
- Janisha Gore
- Meagan A Gore
- Marlon Anthony Graham
- Tia Green
- Vickie Dawn Griffin
- Megan Robyn Griffiths Powell
- Phoebe Grimmer
- Jennifer Stuart Grissom
All providers in Shallotte, NC · Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.