Individual provider Active NPI

Amanda Denicola

  • Physician Assistant
  • Elmira, NY
National Provider Identifier
1780150987
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022806 Issued in NY
Practice address
1138 Broadway St
Elmira, NY 14904-2502
Phone
(607) 734-2695
Fax
(607) 734-2917
NPI assigned
Oct 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022806 NY Primary

Addresses

Primary practice location

1138 Broadway St
Elmira, NY 14904-2502

Mailing address

571 Saint Josephs Blvd
FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050

Other identifiers 1

IdentifierTypeStateIssuer
05397571MedicaidNY

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20181114000108 NY Practitioner - Physician Assistant 3779837539 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arnot Ogden Medical CenterGroup PAC ID 5395798417, 219 clinicians
Arnot Medical Services PLLCGroup PAC ID 0840450748, 91 clinicians

Practice addresses (Care Compare)

1138 Broadway St
Elmira, NY 14904-2502
Phone (607) 734-7982

571 Saint Josephs Blvd
Suite 304
Elmira, NY 14901-3234
Phone (607) 737-7012

600 Roe Ave
Elmira, NY 14905-1629

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.64 of 100Reported as group
Quality
55.31
Promoting interoperability
99
Improvement activities
40
Cost
76.8

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
46.76
Promoting interoperability
100
Improvement activities
40
Cost
77.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022806NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Arnot Ogden Medical Center CurrentSince Mar 1, 2021 Accepting new patients
Arnot Ogden Medical Center CurrentSince Mar 1, 2021 Accepting new patients
Chemung Medical Services PC Past Accepting new patients

Locations

123 Conhocton St
Ste 103
Corning, NY 14830
Phone (607) 438-1200

600 Fitch St
Ste 203
Elmira, NY 14905
Phone (607) 734-2695

1138 Broadway St
Elmira, NY 14904
Phone (607) 734-2695

600 Roe Ave
Elmira, NY 14905
Phone (607) 733-3639

600 Roe Ave
Ste 1F
Elmira, NY 14905
Phone (607) 795-8161

Interoperability endpoints

  • Direct secure messaging: amanda.denicola@arn.eclinicaldirectplus.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1780150987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD",
            "address_2": "FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 BROADWAY ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149042502",
            "telephone_number": "607-734-2695",
            "fax_number": "607-734-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENICOLA",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05397571",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.