Amanda Rezin, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180014340 Issued in IL

Practice address

695 N Perryville Rd Ste 4
Rockford, IL 61107-6225

Phone

(779) 368-0060

Fax

(815) 977-4892

NPI assigned

Sep 14, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Amanda Green Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Behavioral Care Therapy Services of Illinois PCGroup PAC ID 2163944190, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.rezin.1@28621.direct.athenahealth.com

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.

• Optum Behavioral Care Therapy Services of Illinois PC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1235949553
  Medicare reassignment Care Compare group NPD
• KP Counseling LTD

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1770630766
  NPD
• Optum Behavioral Care Therapy Services of Illinois PC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1780579797
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1396415121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 N PERRYVILLE RD STE 4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076225",
            "telephone_number": "779-368-0060",
            "fax_number": "815-977-4892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 N PERRYVILLE RD STE 4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076225",
            "telephone_number": "779-368-0060",
            "fax_number": "815-977-4892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZIN",
        "first_name": "AMANDA",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178-016094",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180014340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "GREEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Reyes
• Kristina Reyez
• Andrea L Reynolds, LMT
• Joanne Lynn Reynolds, OTR
• Lucia Nichole Reynolds, LMT, BCTMB
• David G. Rezin, OTR, CHT
• Janine Spain Rhoades, MD
• Randall Rhodes, MD
• Sharon K. Rhodes, MD
• Elizabeth Paige Rhyne, LCSW

• Professional Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.