Amanda Jean Sevvom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3555 Lutheran Pkwy Ste 340
Wheat Ridge, CO 80033-6039

Phone

(303) 996-6005

Fax

(303) 420-8831

NPI assigned

Oct 7, 2008

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

Other identifiers 1

Other names 1

• Amanda Jean Primm Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1801047956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15747 W 74TH PL",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800077965",
            "telephone_number": "303-921-2038",
            "fax_number": "303-420-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 LUTHERAN PKWY STE 340",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336039",
            "telephone_number": "303-996-6005",
            "fax_number": "303-420-8831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVVOM",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801047956",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "PRIMM",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Wheat Ridge, CO
• Providers in Wheat Ridge, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.