Amanda Marie Allen, PA-C
Individual provider Active NPI Physician Assistant · Peoria, IL
NPI 1376829010 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1376829010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085.004220 (IL)
- Practice address
- 8600 N State Route 91
Suite 300
Peoria, IL 61615-9541 - Phone
- (309) 691-6616
- Fax
- (309) 691-2943
- NPI assigned
- Oct 26, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120518000071 | IL | Practitioner - Physician Assistant | 4981867595 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.004220 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients |
Locations
302 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 662-5361
3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
8600 State Route 91
Ste 300
Peoria, IL 61615
Phone (309) 691-6616
420 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 655-2343
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.004220 | IL | Yes |
Addresses
Primary practice location
8600 N State Route 91
Suite 300
Peoria, IL 61615-9541
Mailing address
2401 W Alta Rd
Apt. 1904
Peoria, IL 61615-1279
Phone (219) 508-5791
Other names
- Amanda Marie Crawford
Other providers in Peoria, IL
- Suzain Ali
- Syed Masood Ali
- Waqas Ali
- All in Wellness, PLLC
- All Ways Caring Services, Inc.
- Collin David Allen
- Johnesha Allen
- Jozie Allen
- Natasha Nicole Allen
- Soraya Allen
All providers in Peoria, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.