Individual provider Active NPI

Amanda Sue Kupris, MD

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1881153955
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024-02722 Issued in NC
Practice address
601 Oberlin Rd
Raleigh, NC 27605-1126
Phone
(919) 235-6566
Fax
(919) 235-6532
NPI assigned
Mar 18, 2019
Last updated
Nov 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD61309883 WA
Family Medicine Physician 207Q00000X 70242 MN
Family Medicine Physician 207Q00000X 2024-02722 NC Primary

Addresses

Primary practice location

601 Oberlin Rd
Raleigh, NC 27605-1126

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0351

Other identifiers 1

IdentifierTypeStateIssuer
1881153955MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220908002635 WA Practitioner - Family Practice 0143553685 Reassigns benefits to 1 organization
I20241212000555 NC Practitioner - Family Practice 0143553685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wake Specialty Physicians LLCGroup PAC ID 7416006085, 178 clinicians

Practice addresses (Care Compare)

601 Oberlin Rd
Raleigh, NC 27605-1126
Phone (919) 235-6566

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29906MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Specialty Phisicians, LLC Family Medicine CurrentSince Dec 16, 2024 Accepting new patients
Kaiser Foundation Health Plan of Washington Single Specialty CurrentSince Jul 27, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jul 27, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington Single Specialty Current Accepting new patients
Wake Specialty Physicians LLC CurrentSince Dec 16, 2024 Accepting new patients
Wake Specialty Physicians, LLC Single Specialty Current Accepting new patients

Locations

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

601 Oberlin Rd
Raleigh, NC 27605
Phone (919) 235-6566

301 S 320th St
Federal Way, WA 98003
Phone (253) 874-7000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: akupris4105780@ghc.direct-ci.net
  • Direct secure messaging: akupris565652@directhisp.wakemed.org

Organizations & group practices 6

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 2

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": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1881153955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 OBERLIN RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051126",
            "telephone_number": "919-235-6566",
            "fax_number": "919-235-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPRIS",
        "first_name": "AMANDA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-18",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61309883",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "70242",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2024-02722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881153955",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.