Active NPI
Amanda C Lee, APRN
- Nurse Practitioner
- Springfield, IL
National Provider Identifier
1124634290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209021451
- Practice address
- 1301 S Koke Mill Rd
Springfield, IL 62711-9252 - Phone
- (217) 547-9230
- Fax
- (217) 547-9236
- NPI assigned
- Sep 23, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041.432814 | IL | |
| Nurse Practitioner | 363L00000X | 209021451 | IL | Primary |
Addresses
Primary practice location
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Mailing address
PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-7578
Other practice location 1
315 W Carpenter St
Springfield, IL 62702-4901
Phone (217) 545-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041.432814 | IL | MD | Registered Nurse |
| 209021451 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Center of Illinois | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- Springfield, IL
- NPI 1144372798
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1124634290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19639",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949639",
"telephone_number": "217-545-7578",
"fax_number": "217-545-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627119252",
"telephone_number": "217-547-9230",
"fax_number": "217-547-9236"
}
],
"practiceLocations": [
{
"address_1": "315 W Carpenter St",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "IL",
"postal_code": "627024901",
"country_code": "US",
"telephone_number": "217-545-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "AMANDA",
"middle_name": "C",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-23",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041.432814",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209021451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.