Amber Lee-Ann Koth, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277001734 Issued in IL

Practice address

221 NE Glen Oak Ave
Peoria, IL 61636-4416

Phone

(309) 672-5500

NPI assigned

Jul 12, 2017

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

Locations

Interoperability endpoints

• Direct secure messaging: akothaprn395398@carlehiedirect.net

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.

• Epss LLC - Central Series

  • Emergency Medicine Physician
  • Pekin, IL
  • NPI 1538680467
  Medicare reassignment NPD
• Epss Peoria LLC

  • Emergency Medicine Physician
  • Peoria, IL
  • NPI 1831421056
  Medicare reassignment NPD
• Epss, LLC- Metro Series

  • Emergency Medicine Physician
  • Peoria, IL
  • NPI 1124782305
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Emergency Care Clinic/Center
  • Peoria, IL
  • NPI 1265966048
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755

  Nurse Practitioner

  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Methodist Medical Center of Illinois

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1184670663
  NPD (past)

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732838400000",
    "number": "1508388372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616364416",
            "telephone_number": "309-672-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616364416",
            "telephone_number": "309-672-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1915 S Mattis Ave",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618215919",
            "country_code": "US",
            "telephone_number": "217-352-0516",
            "fax_number": "217-352-0976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTH",
        "first_name": "AMBER",
        "middle_name": "LEE-ANN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277001734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah R Koscica, MD
• Justyna Anna Koscielniak, APRN, CNP
• Brett Anthony Kosowski, DO
• Anup Harish Kotadia, MD
• Larry J Kotewa, CRNA
• Saad Kothawala, MD
• Thomas F. Kouri, M.D.
• Whitney Kovarik, OTR/L
• Pranitha Kovuri
• Aneta Monika Kowalska, MD

• Family Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; 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.