NPIMap

Individual provider Active NPI

Amanda Nicole Lilly, CNP

  • Family Nurse Practitioner
  • Mansfield, OH
National Provider Identifier
1003290206
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP17720 Issued in OH
Practice address
600 W 3Rd St
Mansfield, OH 44906-2633
Phone
(419) 522-6191
Fax
(419) 525-6723
NPI assigned
Jul 17, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP17720 OH Primary

Addresses

Primary practice location

600 W 3Rd St
Mansfield, OH 44906-2633

Mailing address

600 W 3Rd St
Mansfield, OH 44906-2633
Phone (419) 522-6191

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alilly229257@direct.ohiohealth.com Third Street Community Clinic, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150803002727 OH Practitioner - Nurse Practitioner 0941514053 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Third Street Community Clinic, Inc.Group PAC ID 2365423977, 29 clinicians

Practice addresses (Care Compare)

1404 Park Ave W
Suite 2
Mansfield, OH 44906-2633

600 W 3Rd St
Mansfield, OH 44906-2633
Phone (419) 522-6191

Hospital & facility affiliations

  • Ohiohealth Mansfield Hospital Hospital, Mansfield, OH, CCN 360118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP17720OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Third Street Community Clinic, Inc. Current Accepting new patients
Third Street Community Clinic, Inc CurrentSince Oct 6, 2021 Accepting new patients
Third Street Community Clinic, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Third Street Community Clinic, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Third Street Community Clinic, Inc. CurrentSince Jul 20, 2015 Accepting new patients
Third Street Community Clinic, Inc Past Accepting new patients

Locations

309 Arthur St
Ashland, OH 44805
Phone (419) 282-5959

2458 Stetzer Rd
Unit A
Bucyrus, OH 44820
Phone (419) 834-8889

2458 Stetzer Rd
Ste A
Bucyrus, OH 44820
Phone (419) 834-8889

200 Park Ave W
Mansfield, OH 44902
Phone (419) 522-2239

205 W Cook Rd
Mansfield, OH 44907
Phone (567) 309-7333

270 Sterkel Blvd
Ste A
Mansfield, OH 44907
Phone (419) 526-7866

770 Balgreen Dr
Ste 207
Mansfield, OH 44906
Phone (419) 522-6800

2131 Park Ave W
Ste 200
Ontario, OH 44906
Phone (419) 525-6730

600 W 3rd St
Ontario, OH 44906
Phone (419) 525-6722

1404 Park Ave W
Ste 2
Ontario, OH 44906

31 E Main St
Shelby, OH 44875
Phone (419) 525-6795

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1003290206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W 3RD ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W 3RD ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-17",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP17720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alilly229257@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "Third Street Community Clinic, Inc.",
            "address_1": "600 W 3rd St",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449062633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.