Individual provider Active NPI

Stacy M. Raviv, MD

  • Pulmonary Disease Physician
  • Evanston, IL
National Provider Identifier
1568550499
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036-113373 Issued in IL
Practice address
1000 Central St Ste 615
Evanston, IL 60201-1779
Phone
(847) 570-2714
Fax
(847) 733-5109
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036113373 IL
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036113373 IL
Pulmonary Disease Physician 207RP1001X 036-113373 IL Primary

Addresses

Primary practice location

1000 Central St Ste 615
Evanston, IL 60201-1779

Mailing address

1000 Central St Ste 615
Evanston, IL 60201-1779
Phone (847) 570-2714

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sraviv217161@direct.northshore.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100818001216 IL Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 1951435486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
University of Chicago, Pritzker School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1000 Central St
Evanston, IL 60201-1779

1300 Oak Ave
Evanston, IL 60201-4205
Phone (847) 869-1300

2650 Ridge Ave
Evanston, IL 60201-1700

777 Park Ave W
Highland Park, IL 60035-2433

9600 Gross Point Rd
Skokie, IL 60076-1214

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036113373ILMDInternal Medicine Physician
036-113373ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Internal Medicine CurrentSince Aug 1, 2010 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2010 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

1000 Central St
Ste 615
Evanston, IL 60201
Phone (847) 570-2714

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

1000 Central St
Evanston, IL 60201
Phone (847) 570-1000

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1568550499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CENTRAL ST STE 615",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011779",
            "telephone_number": "847-570-2714",
            "fax_number": "847-733-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CENTRAL ST STE 615",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011779",
            "telephone_number": "847-570-2714",
            "fax_number": "847-733-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVIV",
        "first_name": "STACY",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036113373",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036113373",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-113373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sraviv217161@direct.northshore.org",
            "affiliation": "N",
            "address_1": "1000 Central St Ste 615",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602011779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.