Individual provider Active NPI

Amanda Victoria Soza, MD

  • Pediatrics Physician
  • Kyle, TX
National Provider Identifier
1790215002
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
S7146 Issued in TX
Practice address
22420 Ih 35 Ste 203
Kyle, TX 78640-2656
Phone
(407) 649-6876
Fax
(407) 872-0544
NPI assigned
Jun 19, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X S7146 TX Primary

Addresses

Primary practice location

22420 Ih 35 Ste 203
Kyle, TX 78640-2656

Mailing address

6210 E Highway 290 Ste 420
Austin, TX 78723-1142
Phone (512) 483-9569

Other identifiers 2

IdentifierTypeStateIssuer
419459904MedicaidTX
419459903MedicaidTX

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20200804001943 TX Practitioner - Pediatric Medicine 3375968696 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Regional Clinic, PA Pediatrics CurrentSince Sep 1, 2020 Accepting new patients
Austin Regional Clinic, PA CurrentSince Sep 1, 2020 Accepting new patients

Locations

6835 Austin Center Blvd
Austin, TX 78731
Phone (512) 231-5210

6210 E Highway 290
Ste 420
Austin, TX 78723
Phone (512) 338-3802

151 Exchange Blvd
Ste 500
Hutto, TX 78634
Phone (512) 846-1244

22420 I 35
Ste 203
Kyle, TX 78640
Phone (737) 404-0347

Interoperability endpoints

  • Direct secure messaging: asoza24885@arcmd.direct-ci.com

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": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1790215002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 E HIGHWAY 290 STE 420",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231142",
            "telephone_number": "512-483-9569",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22420 IH 35 STE 203",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786402656",
            "telephone_number": "407-649-6876",
            "fax_number": "407-872-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOZA",
        "first_name": "AMANDA",
        "middle_name": "VICTORIA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "S7146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419459904",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419459903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, TX

Sources for this page

Verify at the official NPI Registry.