Active NPI
Shelby Graham
- Student in an Organized Health Care Education/Training Program
- Chicago, IL
National Provider Identifier
1235710609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1620 W Harrison St
Chicago, IL 60612-3801 - Phone
- (312) 942-5000
- NPI assigned
- Apr 17, 2021
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1620 W Harrison St
Chicago, IL 60612-3801
Mailing address
1620 W Harrison St
Chicago, IL 60612-3801
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0078777 | Other | NO OTTHE PROVIDER IDENTIFIERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230906002385 | KY | Order and Referring Only - Plastic and Reconstructive Surgery | 2466816657 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618617600000",
"number": "1235710609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123801",
"telephone_number": "312-942-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "SHELBY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-17",
"last_updated": "2021-04-17",
"certification_date": "2021-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NO OTTHE PROVIDER IDENTIFIERS",
"identifier": "0078777",
"state": null
}
],
"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 Apr 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.