NPIMap

Individual provider Active NPI

Staci J Ladowitz, PA

  • Medical Physician Assistant
  • Shiloh, IL
National Provider Identifier
1639711963
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085007299 Issued in IL
Practice address
1418 Cross St
Ste 160
Shiloh, IL 62269-2914
Phone
(618) 607-1340
Fax
(618) 433-6492
NPI assigned
Oct 8, 2019
Last updated
Apr 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085007299 IL Primary

Addresses

Primary practice location

1418 Cross St
Ste 160
Shiloh, IL 62269-2914

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (618) 607-1340

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191116000413 IL Practitioner - Physician Assistant 5799117594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1404 Cross St
Shiloh, IL 62269-2988
Phone (314) 362-7200

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (314) 362-7200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.01 of 100Reported as group
Quality
76.14
Promoting interoperability
99
Improvement activities
40
Cost
76.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085007299ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University Physicians in Illinois, Inc CurrentSince Nov 1, 2019 Accepting new patients
Washington University Physicians in Illinois, Inc Past Accepting new patients

Locations

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

1418 Cross St
Ste 160
Shiloh, IL 62269
Phone (618) 607-1320

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1639711963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "618-607-1340",
            "fax_number": "618-433-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 CROSS ST",
            "address_2": "STE 160",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622692914",
            "telephone_number": "618-607-1340",
            "fax_number": "618-433-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LADOWITZ",
        "first_name": "STACI",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-08",
        "last_updated": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085007299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1418 Cross St",
            "address_2": "Ste 160",
            "city": "Shiloh",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shiloh, IL

Sources for this page

Verify at the official NPI Registry.