Active NPI
Jody Sam Dawaliby Crane, DO
- Psychiatry Physician
- Park Ridge, IL
National Provider Identifier
1306549548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 125.082472
- Practice address
- 1875 Dempster St Ste 470
Park Ridge, IL 60068-1129 - Phone
- (847) 795-5865
- Fax
- (847) 723-5882
- NPI assigned
- Mar 27, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 125.082472 | IL | Primary |
Addresses
Primary practice location
1875 Dempster St Ste 470
Park Ridge, IL 60068-1129
Mailing address
1875 Dempster St Ste 47
Park Ridge, IL 60068-1186
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.082472 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701907200000",
"number": "1306549548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1875 DEMPSTER ST STE 47",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1875 DEMPSTER ST STE 470",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681129",
"telephone_number": "847-795-5865",
"fax_number": "847-723-5882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRANE",
"first_name": "JODY",
"middle_name": "SAM DAWALIBY",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-27",
"last_updated": "2023-12-07",
"certification_date": "2023-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "125.082472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.