Amanda Catherine Fraser, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.010647 Issued in IL

Practice address

1100 Broadway
Rockford, IL 61104-1429

Phone

(815) 490-1600

NPI assigned

Jun 17, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Amanda Gallahter Former name

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

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.

• Crusaders Central Clinic Association

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1902972557
  NPD (past)
• Crusaders Central Clinic Association

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1922358373
  NPD (past)

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1609619691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "508-649-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BROADWAY",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611041429",
            "telephone_number": "815-490-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "AMANDA",
        "middle_name": "CATHERINE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.010647",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "GALLAHTER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pradeepa Franklin, PT
• Pamela Jean Franks, MS,CCC-SLP
• Christopher Scott Frantz
• Kathleen A Franzen
• Zackary Thomas Franzen, MD
• Yohannes G Fre, MSN FNP-BC
• Luke Richard Frederick, MD
• Fredric C. Kullberg, M.D.S.C.
• Nancy Fredrick, LCPC
• Fredrickson Counseling P C

• Physician Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.