Stacey Davis, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209.022618 Issued in IL

Practice address

1010 Lake St Ste 100
Oak Park, IL 60301-1106

Phone

(708) 790-5200

NPI assigned

Jan 6, 2021

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Intermind Wellness Inc

  • Psychiatry Physician
  • Calumet Park, IL
  • NPI 1710746672
  NPD Authorized official
• Prosper Mental Health Inc

  • Psychiatry Physician
  • Calumet Park, IL
  • NPI 1760136238
  NPD Authorized official
• Forefront-Rosenzweig Medical Services Professional Corporation

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1588101745

  IL

  Medicare reassignment
• Rad Gharavi MD PC

  • Psychiatry Physician
  • Oak Park, IL
  • NPI 1144495144
  NPD
• Village Mental Health Inc

  • Psychiatry Physician
  • Brooklyn, NY
  • NPI 1194400309
  NPD

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1508454448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 W 127TH ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276537",
            "telephone_number": "708-620-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 100",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011106",
            "telephone_number": "708-790-5200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1137 W 127th St",
            "address_purpose": "LOCATION",
            "city": "Calumet Park",
            "state": "IL",
            "postal_code": "608276537",
            "country_code": "US",
            "telephone_number": "708-620-7807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "STACEY",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-06",
        "last_updated": "2021-03-12",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.022618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chirah Alvinay Davis
• Daryl Ellis Davis, DC
• Georgetta J Davis
• Julene Davis, PMHNP
• Sarah D Davis, EDM
• Kristin R Davisson, PSY.D.
• Dawn Bounds LTD
• Pablo De la Cruz, DPT
• Daisy De la Torre
• Victoria Adriana De la Torre

• Psychiatric/Mental Health Nurse Practitioner in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.