NPIMap

Individual provider Active NPI

Amanda S Sailliez, PAC

  • Physician Assistant
  • Murphysboro, IL
National Provider Identifier
1255305967
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085002568 Issued in IL
Practice address
19 E Shawnee Dr Ste 2
Murphysboro, IL 62966-7072
Phone
(618) 684-2172
Fax
(618) 687-4480
NPI assigned
Feb 17, 2006
Last updated
May 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085002568 IL Primary

Addresses

Primary practice location

19 E Shawnee Dr Ste 2
Murphysboro, IL 62966-7072

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other identifiers 1

IdentifierTypeStateIssuer
085002568MedicaidIL

Other names 1

  • Amanda Caporale Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address asailliez13951@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20051207000735 IL Practitioner - Physician Assistant 4082635917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Arts Clinic LTDGroup PAC ID 3971523077, 3 clinicians

Practice addresses (Care Compare)

19 E Shawnee Dr
Murphysboro, IL 62966-7071

19 E Shawnee Dr
Murphysboro, IL 62966-7072

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: asailliez13951@sih.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1255305967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E SHAWNEE DR STE 2",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629667072",
            "telephone_number": "618-684-2172",
            "fax_number": "618-687-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAILLIEZ",
        "first_name": "AMANDA",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085002568",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asailliez13951@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "19 E Shawnee Dr Ste 2",
            "city": "Murphysboro",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629667072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "CAPORALE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Murphysboro, IL

Sources for this page

Verify at the official NPI Registry.