Alex Zachary Stoller, MS, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

600 W Lake Cook Rd Ste 160
Buffalo Grove, IL 60089-2091

Phone

(847) 632-1880

Fax

(847) 520-6095

NPI assigned

Feb 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Interoperability endpoints

• Direct secure messaging: astoller146248@direct.nch.org

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

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1417549098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W LAKE COOK RD STE 160",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600892091",
            "telephone_number": "847-632-1880",
            "fax_number": "847-520-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W LAKE COOK RD STE 160",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600892091",
            "telephone_number": "847-632-1880",
            "fax_number": "847-520-6095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 W Ontario St Apt 805",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606545784",
            "country_code": "US",
            "telephone_number": "847-609-8998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOLLER",
        "first_name": "ALEX",
        "middle_name": "ZACHARY",
        "credential": "MS, RDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "164008317",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "astoller146248@direct.nch.org",
            "affiliation": "N",
            "address_1": "600 W Lake Cook Rd Ste 160",
            "city": "Buffalo Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600892091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Registered Dietitian in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.

Verify at the official NPI Registry.