AMANDA SUE POULOS PA
NPI 1508377060
Physician Assistant in Philadelphia, PA

Q: What is Amanda Poulos's NPI number?

The NPI number for Amanda Poulos is 1508377060. It was assigned to this individual provider in the NPPES registry on October 23, 2017. The provider is also known as Amanda Davis.

Q: What is Amanda Poulos's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Poulos was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 23, 2017PECOS EnrolledAccepts Medicare Assignment

1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130(215) 235-9600(215) 684-5360 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 9, 2025, Aug 21, 2019, Oct 23, 2017 (3 updates tracked since 2017).

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About Amanda Sue Poulos Pa NPPES

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

AMANDA SUE POULOS PA (NPI 1508377060) is an individual physician assistant in Philadelphia, Pennsylvania, licensed in New Jersey (25MP00931200) and active in the NPI registry since October 2017. She is enrolled in Medicare PECOS, is affiliated with Cooper University Hospital, and maintains a secondary practice location in Camden.

NPPES Registry Identity

NPI1508377060

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameAMANDA SUE POULOSCredential: PA

Location Address1412 FAIRMOUNT AVEPhiladelphia, PA 19130-2908

Mailing Address1 Federal St Ste 200Camden, NJ 08103-1088 · (848) 288-6935 · Fax (732) 790-0107

Phone(215) 235-9600

Fax(215) 684-5360

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateOctober 23, 2017

Last NPPES UpdateSeptember 9, 20253 updates tracked since enumeration

NPPES CertifiedSeptember 9, 2025

✔ NPI 1508377060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NJ · 25MP00931200

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1412 FAIRMOUNT AVE, Philadelphia, PA 19130

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Other Names 1

Former Name (1)Amanda Davis

Secondary Practice Location 1

Location 13 Cooper Plz Rm 300Camden, NJ 08103-1438 · Phone (856) 342-2959

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Amanda Sue Poulos Pa 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 ID6800125162

PECOS Enrollment IDI20250922002013

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Cooper University Hospital

Acute Care Hospitals · Camden, NJ

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310014

Location1 Cooper PlazaCamden, NJ 08103 · Camden County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19130 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

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$74.47 typical visit price

range $19.30 – $147.29

Typical copayment $18.61 (range $4.82 – $36.82)

Most-billed visit code 99213

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 20

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

KAREN EMILY ORZECHOWSKI MD

Student in an Organized Health Care Education/Training Program