Active NPI
Jody Lee Hazel, LMT
- Massage Therapist
- Noble, IL
National Provider Identifier
1093314148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.008542
- Practice address
- 1750 E Colborn Camp LN
Noble, IL 62868-2348 - Phone
- (618) 302-1703
- NPI assigned
- Oct 20, 2020
- Last updated
- Nov 15, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227.008542 | IL | Primary |
Addresses
Primary practice location
1750 E Colborn Camp LN
Noble, IL 62868-2348
Mailing address
1750 E Colborn Camp LN
Noble, IL 62868-2348
Phone (618) 302-1703
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 |
|---|---|---|---|
| 227.008542 | IL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Ridge Orthopedic | Single Specialty | Current | 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": "1603152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668470400000",
"number": "1093314148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 E COLBORN CAMP LN",
"city": "NOBLE",
"state": "IL",
"postal_code": "628682348",
"telephone_number": "618-302-1703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 E COLBORN CAMP LN",
"city": "NOBLE",
"state": "IL",
"postal_code": "628682348",
"telephone_number": "618-302-1703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZEL",
"first_name": "JODY",
"middle_name": "LEE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-20",
"last_updated": "2022-11-15",
"certification_date": "2022-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.008542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Noble, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.