Amanda Glynne Borden

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101274586 Issued in VA

Practice address

501 6TH Ave S
St Petersburg, FL 33701-4634

Phone

(727) 767-4106

Fax

(727) 767-8804

NPI assigned

Mar 22, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Lansdowne, VA
  • NPI 1861552721
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1770043002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-4106",
            "fax_number": "727-767-8804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-4106",
            "fax_number": "727-767-8804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEN",
        "first_name": "AMANDA",
        "middle_name": "GLYNNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101274586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequailty",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "501 6th Ave S",
            "city": "St Petersburg",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337014634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erin Boone
• Wanda M Boote, MD
• Louise Helen Boothby-Llorente, PH.D.
• Karen Boozy, BA
• Brittany Lynette Bordeaux, SLPA
• Heather Borders, MBA, RD, LD/N
• Holly Suzanne Bordon, M.D.
• Kenny Borgas
• Christina Borghi
• Elena Borisenko, ARNP

• Pediatrics Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.