NPIMap

Individual provider Active NPI

Amanda Green, PA-C

  • Physician Assistant
  • Shallotte, NC
National Provider Identifier
1760083059
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-15310 Issued in NC
Practice address
341 Whiteville Rd NW
Shallotte, NC 28470-4507
Phone
(877) 935-5255
NPI assigned
Nov 4, 2020
Last updated
Nov 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-15310 NC Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220408002096 MN Practitioner - Physician Assistant 6204222771
I20260102002000 NC Practitioner - Physician Assistant 6204222771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-15310NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Mar 1, 2022 Accepting new patients
Tri County Community Health Council Inc CurrentSince Dec 3, 2025 Accepting new patients
Tri County Community Health Council Inc CurrentSince Dec 3, 2025 Accepting new patients
Tri County Community Health Council Inc PastSince Nov 24, 2025 Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

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

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763337600000",
    "number": "1760083059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 RAILROAD AVE",
            "city": "ALBANY",
            "state": "MN",
            "postal_code": "563079379",
            "telephone_number": "320-845-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 WHITEVILLE RD NW",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704507",
            "telephone_number": "877-935-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15310",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14006",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shallotte, NC

Sources for this page

Verify at the official NPI Registry.