Active NPI
Christopher R Stadnicki, PA-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1295857076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-001626
- Practice address
- 1901 W Harrison St
Chicago, IL 60612-3714 - Phone
- (773) 869-7488
- Fax
- (773) 869-3578
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085-001626 | IL | |
| Physician Assistant | 363A00000X | 085-001626 | IL | Primary |
Addresses
Primary practice location
1901 W Harrison St
Chicago, IL 60612-3714
Mailing address
14563 Club Circle Dr
Oak Forest, IL 60452-1043
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cstadnicki@direct.ccprovider.org | Direct | Cook County |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-001626 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619740800000",
"number": "1295857076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14563 CLUB CIRCLE DR",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604521043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "773-869-7488",
"fax_number": "773-869-3578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STADNICKI",
"first_name": "CHRISTOPHER",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2021-04-30",
"certification_date": "2021-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IL",
"license": "085-001626",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-001626",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cstadnicki@direct.ccprovider.org",
"affiliation": "Y",
"affiliationName": "Cook County",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1969 W. Ogden Ave.",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606123723",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 30, 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.