Amanda Marie Diamond, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002777 Issued in IL

Practice address

360 Station Drive
Suite 201
Crystal Lake, IL 60014-7978

Phone

(815) 455-7200

Fax

(815) 455-9256

NPI assigned

Jan 25, 2010

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1264377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343865600000",
    "number": "1003147406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 STATION DRIVE",
            "address_2": "SUITE 201",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147978",
            "telephone_number": "815-455-7200",
            "fax_number": "815-455-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 STATION DRIVE",
            "address_2": "SUITE 201",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147978",
            "telephone_number": "815-455-7200",
            "fax_number": "815-455-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAMOND",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-25",
        "last_updated": "2012-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.