Amanda Klics, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

021145 Issued in NY

Practice address

994 W Jericho Tpke Ste 104
Smithtown, NY 11787-3211

Phone

(631) 543-1440

NPI assigned

Aug 7, 2017

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Timothy D. Groth MD PCGroup PAC ID 8921002320, 43 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

86.89 of 100Reported as group

Quality

87.77

Promoting interoperability

100

Improvement activities

40

Cost

68.55

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: amandaklics_37182@timothygrothmdpc.omnimddirect.com

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.

• Timothy D. Groth MD PC

  • Multi-Specialty Clinic/Center
  • Smithtown, NY
  • NPI 1720022015
  Medicare reassignment Care Compare group
• John T. Mather Memorial Hospital

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1376642371
  Medicare reassignment NPD
• John T. Mather Memorial Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1467249334
  Medicare reassignment NPD
• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment
• John T Mather Memorial Hospital

  • Obesity Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1366816894
  NPD
• John T Mather Memorial Hospital

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Port Jefferson, NY
  • NPI 1922486182
  NPD
• John T. Mather Memorial Hospital

  • Emergency Medicine Physician
  • Port Jefferson, NY
  • NPI 1104913748
  NPD
• John T. Mather Memorial Hospital

  dba Breast Center

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1891816070
  NPD
• North Shore - Lij Medical PC

  dba NSLIJ Medical In Queens

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• Pain Management of Long Island, P.C,

  • Pain Medicine (Anesthesiology) Physician
  • Medford, NY
  • NPI 1033267570
  NPD (past)

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1760907125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "994 W JERICHO TPKE STE 104",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873211",
            "telephone_number": "631-543-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 W JERICHO TPKE STE 104",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873211",
            "telephone_number": "631-543-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLICS",
        "first_name": "AMANDA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "AmandaKlics_37182@timothygrothmdpc.omnimddirect.com",
            "affiliation": "N",
            "address_1": "994 W Jericho Tpke Ste 104",
            "city": "Smithtown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117873211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacquelyn Anne Klecak
• Patricia M. Klee
• Richard Klein, DDS
• Sarah Kleinman, MSW
• Nicholas John Kleopoulos M.D., MD
• Deborah Ellen Knapp, LCSW
• Faye Knoll, M.D.
• Alyssa Knott
• Suhas Kochat, MD
• Jafar Kolahifar, MD

• Physician Assistant in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.
• 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.