Active NPI
Robert Powell
- Community Health Worker
- St Charles, IL
National Provider Identifier
1477849388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 160.004470
- Practice address
- 964 N 5TH Ave Ste C
St Charles, IL 60174-1204 - Phone
- (630) 208-4215
- NPI assigned
- Jun 20, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 160.004470 | IL | Primary |
Addresses
Primary practice location
964 N 5TH Ave Ste C
St Charles, IL 60174-1204
Mailing address
239 Valley View Dr
St Charles, IL 60175-4646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36-34784281 | Other | IL | FEIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.004470 | IL | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308528000000",
"number": "1477849388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 VALLEY VIEW DR",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601754646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "964 N 5TH AVE STE C",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601741204",
"telephone_number": "630-208-4215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-20",
"last_updated": "2011-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "IL",
"license": "160.004470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEIN",
"identifier": "36-34784281",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.