Amanda Macke, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209013183 Issued in IL

Practice address

1200 West State Street
Rockford, IL 61102-2112

Phone

(815) 490-1600

Fax

(815) 490-1881

NPI assigned

Aug 2, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Swedishamerican Hospital

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1962451732
  NPD (past)

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1407309941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WEST STATE STREET",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WEST STATE STREET",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKE",
        "first_name": "AMANDA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209013183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Maas, APN, FNP-BC
• Sierra Maaske, APRN
• Nicole Oluwabunmi Macaulay, M.D
• Machesney Bay Dialysis, LLC
• Melissa Yvonne Macias, MD, PHD
• Sean P Mackenzie, M.D.
• Debra Mackey, RN
• Amanda Macquoid, MD
• Catherine J Maculan, DACBSP
• Samragnyi Madala, MD

• Pediatric Nurse Practitioner in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.