Active NPI
Stephen Dale Gannaway, M.A.
- Audiologist-Hearing Aid Fitter
- Joliet, IL
National Provider Identifier
1073615589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist-Hearing Aid Fitter
- License
- 147000243
- Practice address
- 3143 W Jefferson St
Joliet, IL 60435-4733 - Phone
- (815) 744-6898
- Fax
- (815) 744-2486
- NPI assigned
- Sep 4, 2006
- Last updated
- Mar 26, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Audiologist-Hearing Aid Fitter | 237600000X | 147000243 | IL | Primary |
Addresses
Primary practice location
3143 W Jefferson St
Joliet, IL 60435-4733
Mailing address
6 Victory Drive
Liberty, MO 64068
Phone (816) 883-2660
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147000243 | IL | MD | Audiologist-Hearing Aid Fitter |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connect Hearing, Inc. | Audiologist-Hearing Aid Fitter | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1073615589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 VICTORY DRIVE",
"city": "LIBERTY",
"state": "MO",
"postal_code": "64068",
"telephone_number": "816-883-2660",
"fax_number": "816-792-9819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3143 W JEFFERSON ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604354733",
"telephone_number": "815-744-6898",
"fax_number": "815-744-2486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNAWAY",
"first_name": "STEPHEN",
"middle_name": "DALE",
"name_prefix": "Mr.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-04",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "237600000X",
"taxonomy_group": "",
"desc": "Audiologist-Hearing Aid Fitter",
"state": "IL",
"license": "147000243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.