The Black House Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

THE BLACK HOUSE GROUP LLC

Practice address

611 S Wells St Apt 803
Chicago, IL 60607-4783

Phone

(312) 860-4814

NPI assigned

Dec 20, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Tequilla Stanciel, MD

Title

Founder & Chief Medical Provider

Phone

(312) 860-4814

Specialties & licenses 1

Addresses

Other names 1

• HEALTHSQUAD Doing business as

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

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1457011306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S WELLS ST APT 803",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074783",
            "telephone_number": "312-860-4814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S WELLS ST APT 803",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074783",
            "telephone_number": "312-860-4814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BLACK HOUSE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "STANCIEL",
        "authorized_official_first_name": "TEQUILLA",
        "authorized_official_title_or_position": "FOUNDER & CHIEF MEDICAL PROVIDER",
        "authorized_official_telephone_number": "312-860-4814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEALTHSQUAD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.