Individual provider Active NPI

Amy Marie Buck, APN

  • Family Nurse Practitioner
  • O'Fallon, IL
National Provider Identifier
1053587402
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209005545 Issued in IL
Practice address
670 Pierce Blvd
O Fallon, IL 62269-2579
Phone
(618) 206-2070
NPI assigned
May 6, 2008
Last updated
Dec 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 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 209005545 IL Primary

Addresses

Primary practice location

670 Pierce Blvd
O Fallon, IL 62269-2579

Mailing address

670 Pierce Blvd
O Fallon, IL 62269-2579
Phone (618) 206-2070

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address abuck103169@ewd.direct.hshs.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081209000397 IL Practitioner - Nurse Practitioner 4385705334 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

1512 N Green Mount Rd
Suite 108
Ofallon, IL 62269-1953
Phone (618) 624-5510

1836 S Macarthur Blvd
Springfield, IL 62704-4030
Phone (217) 789-1403

1900 E Lake Shore Dr
Suite 330
Decatur, IL 62521-3848
Phone (217) 423-2889

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209005545ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SJL Health Systems Inc CurrentSince Jan 20, 2014 Accepting new patients
St Josephs Hospital Breese of the Hospital Sisters of the Third Orde CurrentSince Mar 8, 2015 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

1512 N Green Mount Rd
Ste 200
O Fallon, IL 62269
Phone (618) 233-0017

9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1053587402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 PIERCE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692579",
            "telephone_number": "618-206-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 PIERCE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692579",
            "telephone_number": "618-206-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCK",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-06",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209005545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abuck103169@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "670 Pierce Blvd",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.