Active NPI
Jamie M. Stickley, AU.D.
- Audiologist
- South Bend, IN
National Provider Identifier
1396773453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 23002348A
- Practice address
- 100 Navarre PL Ste 4460
South Bend, IN 46601-1168 - Phone
- (574) 235-1010
- Fax
- (574) 232-2064
- NPI assigned
- Jun 29, 2006
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 23002348A | IN | Primary |
Addresses
Primary practice location
100 Navarre PL Ste 4460
South Bend, IN 46601-1168
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 261970156 | Other | IN | MEDICARE PTAN |
| 200980700 | Medicaid | IN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23002348A | IN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Otorhinolaryngology, Inc | Audiologist | Past | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642464000000",
"number": "1396773453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 N NILES AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466171924",
"telephone_number": "574-647-1610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 NAVARRE PL STE 4460",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011168",
"telephone_number": "574-235-1010",
"fax_number": "574-232-2064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STICKLEY",
"first_name": "JAMIE",
"middle_name": "M.",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2022-01-18",
"certification_date": "2022-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IN",
"license": "23002348A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "261970156",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200980700",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.