Amanda Butler, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

030068 Issued in NY

Practice address

5 Clay St
Malone, NY 12953-1905

Phone

(518) 483-0705

NPI assigned

Feb 25, 2014

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

Other identifiers 2

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Drexel University College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Canton-Potsdam Hospital Hospital, Potsdam, NY, CCN 330197
• The University of Vermont Health Network-Alice Hy Hospital, Malone, NY, CCN 331321

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.butler.p1@direct.nwhumanservices.nextgenshare.com

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.

• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782

  NY

  Medicare reassignment Care Compare group
• Canton-Potsdam Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Potsdam, NY
  • NPI 1114104445
  Care Compare group NPD
• Alice Hyde Medical Center

  • Critical Access Hospital
  • Malone, NY
  • NPI 1114954682

  NY

  Medicare reassignment
• Alice Hyde Medical Center

  • General Practice Physician
  • Malone, NY
  • NPI 1568735660

  Physician Assistant

  NPD
• Alice Hyde Medical Center

  • Skilled Nursing Facility
  • Malone, NY
  • NPI 1356441349
  NPD (past)
• Canton Potsdam Hospital

  • Physical Therapy Clinic/Center
  • Canton, NY
  • NPI 1770703522
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Alice Hyde Medical Center

  • Critical Access Hospital
  • Malone, NY
  • NPI 1114954682

  Hospital

  Care Compare affiliation
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1861817090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044049",
            "telephone_number": "503-378-7526",
            "fax_number": "503-588-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CLAY ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531905",
            "telephone_number": "518-483-0705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1233 Edgewater St NW",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973044049",
            "country_code": "US",
            "telephone_number": "503-378-7526",
            "fax_number": "503-588-5815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-25",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01676",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA174869",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "15-01676",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA174869",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.butler.p1@direct.nwhumanservices.nextgenshare.com",
            "affiliation": "Y",
            "affiliationName": "Northwest Human Services, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1233 Edgewater St NW",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973044049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kaitlyn E Burke
• Kelsey Burnham, PMHNP
• Brandy Jo Bush
• Cherilyn Madonna Bush
• Emily Anne Marie Bush
• James David Button, LMSW
• Gerald W Cahill, MDPC
• Mathew Carista
• Heather Carr
• Tyler Joseph Carrow, RN

• All providers in Malone, NY
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.