Individual provider Active NPI

Amanda M Clouser

  • Registered Nurse
  • Springfield, IL
National Provider Identifier
1164087276
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
041430883 Issued in IL
Practice address
315 W Carpenter St FL 1
Springfield, IL 62702-4901
Phone
(217) 545-8000
Fax
(217) 545-1141
NPI assigned
May 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041430883 IL Primary

Addresses

Primary practice location

315 W Carpenter St FL 1
Springfield, IL 62702-4901

Mailing address

PO Box 19678
Springfield, IL 62794-9678
Phone (217) 545-8000

Other identifiers 1

IdentifierTypeStateIssuer
041430883OtherILLICENSE

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
I20190731003678 IL Practitioner - Nurse Practitioner 5991031767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

Practice addresses (Care Compare)

315 W Carpenter St
Springfield, IL 62702-4901
Phone (217) 545-8000

Hospital & facility affiliations

  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 1, 2019 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 1, 2019 Accepting new patients
Siu Physicians & Surgeons, Inc Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1600 W Walnut St
South Jacksonville, IL 62650
Phone (217) 245-7275

315 W Carpenter St
Springfield, IL 62702
Phone (217) 545-5817

301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003

315 W Carpenter St
Fl 1
Springfield, IL 62702

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: amandaclouser@siusm.allscriptsdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1164087276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19678",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949678",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W CARPENTER ST FL 1",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024901",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUSER",
        "first_name": "AMANDA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-03",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041430883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "041430883",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.