Amanda McConnell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17114 Issued in CA

Practice address

3613 Vista Way
Oceanside, CA 92056-4522

Phone

(760) 758-5340

NPI assigned

May 11, 2012

Last updated

May 11, 2012By the provider in NPPES

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 names 1

• Amanda Andersen Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatologist Medical Group of North County IncGroup PAC ID 7315849981, 19 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dermatologist Medical Group of North County, Inc

  • Dermatology Physician
  • Oceanside, CA
  • NPI 1538191077
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336694400000",
    "number": "1801155775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564522",
            "telephone_number": "760-758-5340",
            "fax_number": "760-758-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564522",
            "telephone_number": "760-758-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-11",
        "last_updated": "2012-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ANDERSEN",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hunter McKenzie McCleary, NP
• Jonathan McClellan, RADT-1
• Joshua McClintock
• Mark McClure
• Trudy Louise McClure
• James Howard McCook, D.D.S.
• Portia R McCord
• Sarah McCormick
• Maile M McCoy
• Jillana Joy McCray, LCSW

• Physician Assistant in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.