Individual provider Active NPI

Amanda G Smith

  • Psychiatric/Mental Health Nurse Practitioner
  • Queensbury, NY
National Provider Identifier
1861112757
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
403565 Issued in NY
Practice address
25 Willowbrook Rd
Queensbury, NY 12804-5882
Phone
(518) 926-7100
NPI assigned
Aug 31, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 668433 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 403565 NY Primary

Addresses

Primary practice location

25 Willowbrook Rd
Queensbury, NY 12804-5882

Mailing address

25 Willowbrook Rd
Queensbury, NY 12804-5882
Phone (518) 926-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20230307002000 NY Practitioner - Nurse Practitioner 0749653004 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2155 State Route 22B
Morrisonville, NY 12962-3417
Phone (518) 563-8000

340 Main St
Hudson Falls, NY 12839-1530
Phone (518) 747-8001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
668433NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Services North, Inc. CurrentSince Dec 1, 2022 Accepting new patients
Behavioral Health Services North, Inc. CurrentSince Dec 1, 2022 Accepting new patients

Locations

2155 State Route 22B
Morrisonville, NY 12962
Phone (518) 562-3847

22 US Oval
Ste 218
Plattsburgh, NY 12903
Phone (518) 534-9666

25 Willowbrook Rd
Queensbury, NY 12804
Phone (518) 793-9156

Organizations & group practices 3

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": "1661904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1861112757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 WILLOWBROOK RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128045882",
            "telephone_number": "518-926-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 WILLOWBROOK RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128045882",
            "telephone_number": "518-926-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-31",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "668433",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queensbury, NY

Sources for this page

Verify at the official NPI Registry.