Stat Tbi and Concussion Diagnostics

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Legal business name

STAT TBI AND CONCUSSION DIAGNOSTICS

Practice address

1100 Lake St Ste LL56
Oak Park, IL 60301-1034

Phone

(800) 767-8903

Fax

(888) 221-4798

NPI assigned

Jan 5, 2024

Organization subpart

No

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

Authorized official

Name

Darnell Randall

Title

Ceo

Phone

(678) 372-3765

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1467222844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 SANDY PLAINS RD",
            "address_2": "SUITE 200 PMB 2058",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30066",
            "telephone_number": "800-767-8903",
            "fax_number": "888-221-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LAKE ST STE LL56",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011034",
            "telephone_number": "800-767-8903",
            "fax_number": "888-221-4798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAT TBI AND CONCUSSION DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "DARNELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-372-3765"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Christine Starin, MSW, LCSW
• Patricia J Starkey, DPT
• Starks Therapy Group
• Autumn E Starks, LCSW
• Meredith Starnes
• Katherine Staub, SLP
• Amy Elizabeth Stearns, PH.D.
• Sanna Stella, LCPC, NCC
• Sara C Stepanovich, LSW
• Mona Stepansky, PH.D.

• Other Specialist/Technologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Other Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.