NPIMap

Individual provider Active NPI

Amanda Michelle Penegar, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1962809160
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05222 Issued in NC
Practice address
10650 Park Rd
Ste 480
Charlotte, NC 28210-8538
Phone
(704) 667-0520
NPI assigned
Dec 3, 2014
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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 0010-05222 NC Primary

Addresses

Primary practice location

10650 Park Rd
Ste 480
Charlotte, NC 28210-8538

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

16455 Statesville Rd
Ste 200
Huntersville, NC 28078-7135
Phone (704) 801-3011

Other practice location 2

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963
Phone (704) 355-4593

Other practice location 3

1225 Harding Pl
Ste 5100
Charlotte, NC 28204-2826
Phone (704) 355-8850

Other practice location 4

10650 Park Rd
Ste 480
Charlotte, NC 28210-8538
Phone (704) 667-8860

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address apenegar499666@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160525002003 NC Practitioner - Physician Assistant 3971892357 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Atrium Health Specialty Network IncGroup PAC ID 5193245801, 248 clinicians

Practice addresses (Care Compare)

1100 Healing Way
Matthews, NC 28104-4951
Phone (980) 993-1844

4525 Cameron Valley Pkwy
Charlotte, NC 28211-4369
Phone (704) 468-8874

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-05222NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Jan 2, 2023 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 2, 2023 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 2, 2023 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 2, 2023 Accepting new patients
Carolina Digestive Health Associates, PA PastSince Oct 29, 2023 Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

4525 Cameron Valley Pkwy
Charlotte, NC 28211
Phone (704) 355-5100

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

1225 Harding Pl
Ste 5100
Charlotte, NC 28204
Phone (704) 355-8850

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204
Phone (704) 355-1813

10650 Park Rd
Ste 480
Charlotte, NC 28210
Phone (704) 355-1813

16455 Statesville Rd
Ste 200
Huntersville, NC 28078
Phone (704) 302-8600

Interoperability endpoints

  • Direct secure messaging: apenegar499666@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 9

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 9

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": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1962809160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10650 PARK RD",
            "address_2": "STE 480",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108538",
            "telephone_number": "704-667-0520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16455 Statesville Rd",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280787135",
            "country_code": "US",
            "telephone_number": "704-801-3011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1025 Morehead Medical Dr",
            "address_2": "Ste 300",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042963",
            "country_code": "US",
            "telephone_number": "704-355-4593",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1225 Harding Pl",
            "address_2": "Ste 5100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042826",
            "country_code": "US",
            "telephone_number": "704-355-8850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_2": "Ste 480",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-667-8860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENEGAR",
        "first_name": "AMANDA",
        "middle_name": "MICHELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apenegar499666@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "10650 Park Rd",
            "address_2": "Ste 480",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282108538",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.