Individual provider Active NPI

Tracy A Diehl, LCSW

  • Case Manager/Care Coordinator
  • Dekalb, IL
National Provider Identifier
1013662881
Registry record updated Feb 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
570 Devonaire Pkwy
Dekalb, IL 60115-8502
Phone
(815) 761-3382
NPI assigned
Feb 19, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

570 Devonaire Pkwy
Dekalb, IL 60115-8502

Mailing address

570 Devonaire Pkwy
Dekalb, IL 60115-8502
Phone (815) 761-3382

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220907003484 IL Practitioner - Clinical Social Worker 0941684138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitae Health Medical Illinois, PLLCGroup PAC ID 2365798410, 214 clinicians

Practice addresses (Care Compare)

1212 S 2ND St
Dekalb, IL 60115-4435
Phone (815) 758-8151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC CurrentSince Jun 13, 2022 Accepting new patients

Locations

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

1212 S 2nd St
DeKalb, IL 60115
Phone (815) 758-8151

3450 Oakton St
Ste 300
Skokie, IL 60076

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
  • IL HMO C-SNP

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.

NPI Registry JSON

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

{
    "created_epoch": "1645228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645228800000",
    "number": "1013662881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 DEVONAIRE PKWY",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601158502",
            "telephone_number": "815-761-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 DEVONAIRE PKWY",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601158502",
            "telephone_number": "815-761-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "TRACY",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-19",
        "last_updated": "2022-02-19",
        "certification_date": "2022-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.