Individual provider Active NPI

Amanda Platter

  • Clinical Child & Adolescent Psychologist
  • Las Vegas, NV
National Provider Identifier
1972886711
Registry record updated Sep 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Practice address
4955 S Durango Dr Ste 207
Las Vegas, NV 89113-0156
Phone
(702) 650-6508
NPI assigned
Sep 27, 2011
Last updated
Sep 27, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X NU Primary

Addresses

Primary practice location

4955 S Durango Dr Ste 207
Las Vegas, NV 89113-0156

Mailing address

4955 S Durango Dr Ste 207
Las Vegas, NV 89113-0156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150902003168 HI Practitioner - Clinical Psychologist 1951617166 Reassigns benefits to 1 organization
Practice locations: Kailua Kona, HI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

75 -170 Hualalai Rd
Suite D212
Kailua Kona, HI 96740-1780
Phone (808) 450-3816

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan Inc Current Accepting new patients
Kaiser Foundation Health Plan, Inc CurrentSince Jul 18, 2015 Accepting new patients
Kaiser Foundation Health Plan Inc CurrentSince Jul 18, 2015 Accepting new patients

Locations

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

74-517 Honokohau St
Kailua Kona, HI 96740
Phone (808) 334-4400

599 Farrington Hwy
Kapolei, HI 96707
Phone (808) 432-3600

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1972886711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 S DURANGO DR STE 207",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891130156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 S DURANGO DR STE 207",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891130156",
            "telephone_number": "702-650-6508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLATTER",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.