Individual provider Active NPI

Amanda Jo Petri, M.A.

  • Audiologist
  • Woodbury, MN
National Provider Identifier
1760547269
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
8026 Issued in MN
Practice address
217 Radio Dr
Woodbury, MN 55125-5805
Phone
(651) 702-0750
Fax
(651) 645-6166
NPI assigned
Dec 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 8026 MN Primary

Addresses

Primary practice location

217 Radio Dr
Woodbury, MN 55125-5805

Mailing address

215 Radio Dr Ste 202
Woodbury, MN 55125-5822
Phone (651) 702-0750

Other practice location 1

3590 Arcade St
Vadnais Heights, MN 55127-7135
Phone (651) 702-0750

Other practice location 2

11020 161st Street West
Lakeville, MN 55044
Phone (651) 702-0750

Other practice location 3

3460 Promenade Ave
Eagan, MN 55123-4404
Phone (651) 702-0750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071110000020 MN Practitioner - Qualified Audiologist 5496843310 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

217 Radio Dr
Woodbury, MN 55125-5805
Phone (651) 702-0750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
8026MNMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Ancillary Services, Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1760547269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 202",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255822",
            "telephone_number": "651-702-0750",
            "fax_number": "651-645-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255805",
            "telephone_number": "651-702-0750",
            "fax_number": "651-645-6166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3590 Arcade St",
            "address_purpose": "LOCATION",
            "city": "Vadnais Heights",
            "state": "MN",
            "postal_code": "551277135",
            "country_code": "US",
            "telephone_number": "651-702-0750",
            "fax_number": "651-645-6166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11020 161st Street West",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "55044",
            "country_code": "US",
            "telephone_number": "651-702-0750",
            "fax_number": "651-645-6166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3460 Promenade Ave",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551234404",
            "country_code": "US",
            "telephone_number": "651-702-0750",
            "fax_number": "651-645-6166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRI",
        "first_name": "AMANDA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "8026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.