Active NPI
Amanda M Fagan
- Paramedic
- Gardner, IL
National Provider Identifier
1790664142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Paramedic
- License
- 000828467
- Practice address
- 206 Depot St
Gardner, IL 60424-9441 - Phone
- (815) 557-0980
- NPI assigned
- Aug 29, 2025
- 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 |
|---|---|---|---|---|
| Paramedic | 146L00000X | 000828467 | IL | Primary |
Addresses
Primary practice location
206 Depot St
Gardner, IL 60424-9441
Mailing address
684 Circle Dr
Coal City, IL 60416-4003
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000828467 | IL | MD | Paramedic |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1790664142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "684 CIRCLE DR",
"city": "COAL CITY",
"state": "IL",
"postal_code": "604164003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 DEPOT ST",
"city": "GARDNER",
"state": "IL",
"postal_code": "604249441",
"telephone_number": "815-557-0980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "AMANDA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-29",
"last_updated": "2025-08-29",
"certification_date": "2025-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "146L00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Paramedic",
"state": "IL",
"license": "000828467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardner, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.