AMANDA MARIE ILAG AGNP
NPI 1114745783
Nurse Practitioner - Primary Care in Berkeley, CA

Q: What is Amanda Ilag's NPI number?

The NPI number for Amanda Ilag is 1114745783. It was assigned to this individual provider in the NPPES registry on October 1, 2024.

Q: What is Amanda Ilag's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Ilag was last updated on January 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 01, 2024PECOS EnrolledAccepts Medicare Assignment

1901 4TH ST STE 201, BERKELEY, CA 94710(510) 929-1400(510) 929-1414 Get Directions Write a Review

NPPES record last updated: January 16, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Amanda Marie Ilag Agnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA MARIE ILAG AGNP (NPI 1114745783) is an individual primary care provider in Berkeley, California, licensed in California (95032119) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1114745783

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameAMANDA MARIE ILAGCredential: AGNP

Location Address1901 4TH ST STE 201Berkeley, CA 94710-1986

Mailing AddressPo Box 511250Los Angeles, CA 90051-7805 · (510) 929-1400 · Fax (510) 929-1414

Phone(510) 929-1400

Fax(510) 929-1414

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateOctober 1, 2024

Last NPPES UpdateJanuary 16, 2025

NPPES CertifiedJanuary 15, 2025

✔ NPI 1114745783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

License✔ Licensed in CA · 95032119

1901 4TH ST STE 201, Berkeley, CA 94710

Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Amanda Marie Ilag Agnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5193254779

PECOS Enrollment IDI20250128000862

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Amanda Ilag reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pine Park Health, Inc

Same address

Internal Medicine

1901 4TH ST STE 201
Berkeley, CA 94710

Reassigned Medicare billing, California enrollment
21 clinicians in this Medicare group

NPI 1346879848 (510) 929-1400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94710 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$104.51 typical visit price

range $69.00 – $202.35

Typical copayment $26.12 (range $17.25 – $50.58)

Most-billed visit code 99203

Established Patient

$119.48 typical visit price

range $23.44 – $166.46

Typical copayment $29.87 (range $5.86 – $41.61)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHAEL DAVID GENUALDI M.D.

Internal Medicine (Geriatric Medicine)