Staci Vanderjack, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.136063 Issued in IL

Practice address

9555 S 52ND Ave Ste F
Oak Lawn, IL 60453-3054

Phone

(708) 422-5700

Fax

(708) 422-8225

NPI assigned

May 22, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Northwestern University Feinberg Medical School, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
• Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: svanderjack205774@direct.myadvocateaurora.org
• Direct secure messaging: staci.vanderjack.1@20867.direct.athenahealth.com

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.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment Care Compare group NPD
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD

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

• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  Care Compare affiliation
• Advocate Health and Hospitals Corporation

  • General Acute Care Hospital
  • Oak Lawn, IL
  • NPI 1548375082
  Care Compare affiliation
• Ehs Home Health Care Service Inc

  • Home Health Agency
  • Oak Brook, IL
  • NPI 1598732075
  Care Compare affiliation

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1427318666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 S 52ND AVE STE F",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533054",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 S 52ND AVE STE F",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533054",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4140 Southwest Hwy",
            "address_purpose": "LOCATION",
            "city": "Hometown",
            "state": "IL",
            "postal_code": "604561135",
            "country_code": "US",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERJACK",
        "first_name": "STACI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-22",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.136063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "svanderjack205774@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9555 S 52nd Ave Ste F",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604533054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Henry Van Bergen, MD
• Elizabeth Josephine Van Buren
• Leah Margaret Van Slambrouck, M.D.
• Thu Trang L Van, PHARMACIST
• Adam Joseph Vander Weit
• Amanda Vandervelde, PT
• Roseann Marie Vanduren
• Vanessa Hagan, MD, SC
• Danielle Vaquer, MA, LAMFT
• Harsha Varadhi, MD

• Family Medicine Physician in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.