Individual provider Active NPI

Amanda Lynn Notley, PA-C

  • Physician Assistant
  • Bradenton, FL
National Provider Identifier
1902318181
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9114182 Issued in FL
Practice address
8000 Sr 64 E
Bradenton, FL 34212
Phone
(941) 792-1404
Fax
(941) 761-0712
NPI assigned
Oct 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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 PA9114182 FL Primary

Addresses

Primary practice location

8000 Sr 64 E
Bradenton, FL 34212

Mailing address

8000 Sr 64 E
Bradenton, FL 34212
Phone (941) 792-1404

Other identifiers 1

IdentifierTypeStateIssuer
JG6PMOtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210311000379 FL Practitioner - Physician Assistant 4688080955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6202 17TH Ave W
Bradenton, FL 34209-7838
Phone (941) 792-1404

8340 Lakewood Ranch Blvd
Suite 300
Lakewood Ranch, FL 34202-5046
Phone (941) 792-1404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
50.36 of 100Reported as group
Quality
43.71
Promoting interoperability
0
Improvement activities
40
Cost
74.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9114182FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Orthopedics & Sports Medicine of Southwest Florida PA CurrentSince Apr 5, 2021 Accepting new patients

Locations

6015 Pointe West Blvd
Ste 100
Bradenton, FL 34209
Phone 9417921404 ext. 3147

6015 Pointe West Blvd
Bradenton, FL 34209
Phone (941) 782-0101

8000 State Road 64 E
Bradenton, FL 34212
Phone 94179214043315

6202 17th Ave W
Bradenton, FL 34209

8340 Lakewood Ranch Blvd
Ste 300
Lakewood Ranch, FL 34202
Phone (941) 316-8200

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1509148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1902318181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 SR 64 E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34212",
            "telephone_number": "941-792-1404",
            "fax_number": "941-761-0712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 SR 64 E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34212",
            "telephone_number": "941-792-1404",
            "fax_number": "941-761-0712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOTLEY",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-28",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9114182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "JG6PM",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.