Amanda Christine Scully, MD, FAAP

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD219243 Issued in OR

Practice address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Phone

(503) 418-5700

Fax

(503) 418-5704

NPI assigned

Mar 23, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ascully173919@direct.ohsu.edu

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 Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Pediatrics, WA

  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• University Professional Services

  • General Practice Physician
  • Portland, OR
  • NPI 1376709535
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Legacy Emanuel Hospital & Health Center

  • Psychiatric Hospital Unit
  • Portland, OR
  • NPI 1245773225
  NPD
• Legacy Emanuel Hospital & Health Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• South Salem Rehabilitation, LLC

  • Skilled Nursing Facility
  • Salem, OR
  • NPI 1215071998
  NPD
• University Professional Services

  • Pharmacy
  • Beaverton, OR
  • NPI 1073054714
  NPD

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1790216596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-5700",
            "fax_number": "503-418-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-5700",
            "fax_number": "503-418-5704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hermann Museum Circle Dr Apt 4047",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770047388",
            "country_code": "US",
            "telephone_number": "210-836-6325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2800 N Vancouver Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271648",
            "country_code": "US",
            "telephone_number": "503-276-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCULLY",
        "first_name": "AMANDA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "MD, FAAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-23",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "TX",
            "license": "S6036",
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "OR",
            "license": "MD219243",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD219243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1 Hermann Museum Circle Dr Apt 4047",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770047388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Holly Ann Scrugham
• SCS of Oregon, a Professional Corporation
• SCSM Inc.
• Phil Scuderi
• Dorian Scull, PA-C
• SD Wellness LLC
• Athena L Sdrales, DO
• Andrei D Sdrulla, MD, PHD
• Rachel Layne Sdrulla, CRNP
• SE Jung Shin MD Professional Corporation

• Pediatrics Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.