Active NPI
Stacy Bly
- Specialist
- Chicago, IL
National Provider Identifier
1164744652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 070009463
- Practice address
- 663 W Grace St
Chicago, IL 60613-4026 - Phone
- (773) 555-5555
- NPI assigned
- Feb 24, 2010
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 070009463 | IL | Primary |
Addresses
Primary practice location
663 W Grace St
Chicago, IL 60613-4026
Mailing address
663 W Grace St Apt 306
Chicago, IL 60613-4024
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 |
|---|---|---|---|
| 070009463 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274054400000",
"number": "1164744652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "663 W GRACE ST APT 306",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606134024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "663 W GRACE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606134026",
"telephone_number": "773-555-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLY",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-24",
"last_updated": "2010-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "070009463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.