Individual provider Active NPI

Tracy A Stevens

  • Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1417486663
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209-016439 Issued in IL
Practice address
1340 Charles St Ste 100
Rockford, IL 61104-2200
Phone
(779) 696-8700
NPI assigned
Jun 9, 2017
Last updated
Mar 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209-016439 IL Primary
Registered Nurse 163W00000X 041384954 IL

Addresses

Primary practice location

1340 Charles St Ste 100
Rockford, IL 61104-2200

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tstevens915172@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170927002554 IL Practitioner - Nurse Practitioner 9436423530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1401 E State St
Rockford, IL 61104-2315
Phone (815) 489-4400

209 9TH St
Suite 200
Rockford, IL 61104-2235
Phone (779) 696-2750

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as group
Quality
83.2
Promoting interoperability
77
Improvement activities
40
Cost
71.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041384954ILMDRegistered Nurse
209-016439ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Sep 5, 2017 Accepting new patients
Swedishamerican Hospital Current Accepting new patients
Swedishamerican Hospital CurrentSince Sep 5, 2017 Accepting new patients

Locations

1401 E State St
Fl 2
Rockford, IL 61104
Phone (779) 696-8050

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

1340 Charles St
Ste 100
Rockford, IL 61104
Phone (779) 696-1900

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

Interoperability endpoints

  • Direct secure messaging: tstevens915172@direct.uwhealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1417486663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CHARLES ST STE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042200",
            "telephone_number": "779-696-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "TRACY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-016439",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041384954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tstevens915172@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1340 Charles St Ste 100",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611042200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.