Active NPI
Maria Staed Dwyer
- Neurology Physical Therapist
- Park Ridge, IL
National Provider Identifier
1598370231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physical Therapist
- License
- 070006676
- Practice address
- 1775 Dempster St
Park Ridge, IL 60068-1143 - Phone
- (847) 723-7501
- NPI assigned
- Sep 10, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Neurology Physical Therapist | 2251N0400X | 070006676 | IL | Primary |
Addresses
Primary practice location
1775 Dempster St
Park Ridge, IL 60068-1143
Mailing address
107 N Evanston Ave
Arlington Heights, IL 60004-6617
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07000-6676 | Other | IL | PT LICENSE |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mdwyer249484@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070006676 | IL | MD | Neurology Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639180800000",
"number": "1598370231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 N EVANSTON AVE",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600046617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 DEMPSTER ST",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681143",
"telephone_number": "847-723-7501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DWYER",
"first_name": "MARIA",
"middle_name": "STAED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-10",
"last_updated": "2021-12-11",
"certification_date": "2021-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "2251N0400X",
"taxonomy_group": "",
"desc": "Physical Therapist, Neurology",
"state": "IL",
"license": "070006676",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "07000-6676",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mdwyer249484@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1775 Dempster St",
"city": "Park Ridge",
"state": "IL",
"country_code": "US",
"postal_code": "600681143",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "1775 Dempster St",
"city": "Park Ridge",
"state": "IL",
"country_code": "US",
"postal_code": "600681143",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.