Amanda Wortman, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CP001742 Issued in SD

Practice address

24276 166TH St, Airport Rd
Eagle Butte, SD 57625-1012

Phone

(605) 964-7724

NPI assigned

Mar 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Eagle Butte Indian Health Service Hospital

  • Public Health or Welfare Agency
  • Eagle Butte, SD
  • NPI 1558395848

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1972139095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MERCURY ST",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575015672",
            "telephone_number": "605-939-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24276 166TH ST, AIRPORT RD",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576251012",
            "telephone_number": "605-964-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORTMAN",
        "first_name": "AMANDA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-20",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP001742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Watters, PHARMD
• Adrienne Coleen Widow
• Jauron Brandt Widow
• Stephen Andrew Williams, RN
• Angel Lee Wilson-Crowe, ARNP
• Theresa A Yazzie, LPN
• Kathleeen Kae Zambo, CNP
• Judy Zhang, PHARMD, RPH

• Family Nurse Practitioner in Eagle Butte, SD
• Providers in Eagle Butte, SD by specialty
• Family Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.