Individual provider Active NPI

Amanda M Manning, P.A.

  • Physician Assistant
  • Roseburg, OR
National Provider Identifier
1851849954
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA188302 Issued in OR
Practice address
2570 NW Edenbower Blvd.
Suite 100
Roseburg, OR 97471-6214
Phone
(541) 677-7200
Fax
(541) 229-3309
NPI assigned
Sep 17, 2016
Last updated
Sep 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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 PA188302 OR Primary

Addresses

Primary practice location

2570 NW Edenbower Blvd.
Suite 100
Roseburg, OR 97471-6214

Mailing address

1515 Village Dr
Cottage Grove, OR 97424-9700
Phone (360) 729-1253

Other practice location 1

1515 Village Dr
Cottage Grove, OR 97424-9700
Phone (541) 767-5222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20181128002236 OR Practitioner - Physician Assistant 8729322904 Reassigns benefits to 4 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
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

1800 Coburg Rd
Eugene, OR 97401-4995
Phone (541) 345-8760

186 W Ellendale Ave
Dallas, OR 97338-1408
Phone (541) 640-7625

355 W 3Rd Ave
Junction City, OR 97448-1313
Phone (541) 998-6750

3737 Shasta Way
Suite a
Klamath Falls, OR 97603-4982
Phone (541) 640-7625

4040 W 11TH Ave
Suite B
Eugene, OR 97402-5601
Phone (541) 500-2500

598 E 13TH Ave
Eugene, OR 97401-4783
Phone (541) 636-3473

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA188302ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC CurrentSince Jan 6, 2025 Accepting new patients
Icco LLC CurrentSince Jan 6, 2025 Accepting new patients
Peacehealth Medical Group Cottage Grove Current Accepting new patients

Locations

1515 Village Dr
Cottage Grove, OR 97424
Phone (541) 767-5200

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

3675 Pacific Ave
#101
Forest Grove, OR 97116
Phone (971) 762-4611

1890 NW 6th St
Grants Pass, OR 97526
Phone (541) 507-0684

3737 Shasta Way
Ste A
Klamath Falls, OR 97603
Phone (541) 883-2337

3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605

Interoperability endpoints

  • Direct secure messaging: arose366640@direct.peacehealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1474070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1851849954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "360-729-1253",
            "fax_number": "541-229-3309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2570 NW EDENBOWER BLVD.",
            "address_2": "SUITE 100",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974716214",
            "telephone_number": "541-677-7200",
            "fax_number": "541-229-3309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Village Dr",
            "address_purpose": "LOCATION",
            "city": "Cottage Grove",
            "state": "OR",
            "postal_code": "974249700",
            "country_code": "US",
            "telephone_number": "541-767-5222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANNING",
        "first_name": "AMANDA",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-17",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA188302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.