Individual provider Active NPI

Amanda Lyn Weed, APN

  • Adult Health Clinical Nurse Specialist
  • Bloomington, IL
National Provider Identifier
1578942686
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X
License
209012318 Issued in IL
Practice address
2200 E Washington St
Bloomington, IL 61701-4364
Phone
(309) 662-3311
Fax
(309) 664-0969
NPI assigned
May 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 209012318 IL Primary

Addresses

Primary practice location

2200 E Washington St
Bloomington, IL 61701-4364

Mailing address

24915 N Copperas Creek Rd
Canton, IL 61520-8644
Phone (309) 232-5183

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150805009608 IL Practitioner - Nurse Practitioner 0446564330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
209012318ILMDAdult Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients

Locations

1505 Eastland Dr
Ste 1100
Bloomington, IL 61701
Phone (309) 663-2100

2200 E Washington St
Bloomington, IL 61701
Phone (309) 662-3311

801 Fox Run
Heyworth, IL 61745
Phone (309) 473-2069

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1578942686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24915 N COPPERAS CREEK RD",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615208644",
            "telephone_number": "309-232-5183",
            "fax_number": "309-664-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E WASHINGTON ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014364",
            "telephone_number": "309-662-3311",
            "fax_number": "309-664-0969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEED",
        "first_name": "AMANDA",
        "middle_name": "LYN",
        "name_prefix": "Ms.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209012318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.