Active NPI
Stephanie Pearlette Powell, PA-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1417040403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-001414
- Practice address
- 500 E 51St St
Room 7021E
Chicago, IL 60615-2400 - Phone
- (312) 572-2743
- Fax
- (312) 572-2799
- NPI assigned
- Oct 2, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085-001414 | IL | |
| Physician Assistant | 363A00000X | 085-001414 | IL | Primary |
Addresses
Primary practice location
500 E 51St St
Room 7021E
Chicago, IL 60615-2400
Mailing address
500 E 51St St
Room 7021E
Chicago, IL 60615-2400
Phone (773) 572-2743
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085001414 | Other | IL | PA LICENSE NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | spowell2@direct.ccprovider.org | Direct | Cook County |
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 |
|---|---|---|---|
| 085-001414 | IL | MD | Medical Physician Assistant |
Interoperability endpoints
- spowell2@direct.ccprovider.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619568000000",
"number": "1417040403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E 51ST ST",
"address_2": "ROOM 7021E",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606152400",
"telephone_number": "773-572-2743",
"fax_number": "773-572-2799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E 51ST ST",
"address_2": "ROOM 7021E",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606152400",
"telephone_number": "312-572-2743",
"fax_number": "312-572-2799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "STEPHANIE",
"middle_name": "PEARLETTE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2021-04-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IL",
"license": "085-001414",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-001414",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE NUMBER",
"identifier": "085001414",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "spowell2@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 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.