Active NPI
Amanda M. Schallman, PA-C
- Physician Assistant
- Skokie, IL
National Provider Identifier
1629470315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-005169
- Practice address
- 9711 Skokie Blvd
Suite J
Skokie, IL 60077-1384 - Phone
- (847) 675-9711
- NPI assigned
- Sep 24, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-005169 | IL | Primary |
Addresses
Primary practice location
9711 Skokie Blvd
Suite J
Skokie, IL 60077-1384
Mailing address
9711 Skokie Blvd
Suite J
Skokie, IL 60077-1384
Phone (847) 675-9711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085-005169 | Other | IL | ILLINOIS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-005169 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Dermpath Laboratory | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dermatopathology Physician
- Park Ridge, IL
- NPI 1376866897
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411516800000",
"number": "1629470315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9711 SKOKIE BLVD",
"address_2": "SUITE J",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600771384",
"telephone_number": "847-675-9711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9711 SKOKIE BLVD",
"address_2": "SUITE J",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600771384",
"telephone_number": "847-675-9711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHALLMAN",
"first_name": "AMANDA",
"middle_name": "M.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-24",
"last_updated": "2014-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-005169",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS LICENSE",
"identifier": "085-005169",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.