Tracy Shadley, FNP

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

277.001865 Issued in IL

Practice address

7220 Great Hill Rd
Crystal Lake, IL 60012-1637

Phone

(847) 999-8777

Fax

(815) 893-4534

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Rockford Psychiatric Medical Services SCGroup PAC ID 6901089515, 154 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

58.33 of 100Reported as group

Quality

41.25

Promoting interoperability

0

Improvement activities

40

Cost

69.86

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tracy.shadley.1@25899.direct.athenahealth.com

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.

• Rockford Psychiatric Medical Services, S.C.

  • Psychiatry Physician
  • Rockford, IL
  • NPI 1821391442
  Medicare reassignment Care Compare group NPD
• Chestnut Health of Illinois LLC

  • Internal Medicine Physician
  • Elgin, IL
  • NPI 1588043939
  Medicare reassignment NPD
• Glenwood Center LTD

  • Psychiatry Physician
  • Rockford, IL
  • NPI 1003033861
  Medicare reassignment

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1699263731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 NEWBURG RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611086479",
            "telephone_number": "815-988-8500",
            "fax_number": "815-977-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7220 GREAT HILL RD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600121637",
            "telephone_number": "847-999-8777",
            "fax_number": "815-893-4534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADLEY",
        "first_name": "TRACY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277.001865",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277.001865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Senior Lifestyle Solutions, LTD.
• Senior Lifestyle Solutions, LTD.
• Andrea Sept, M.A., CCC-SLP/L
• Natalye Serrano, RBT
• Jill L Shadel, CDS
• Aleen Shah, PA-C
• Hemang P Shah, PHARMD
• Pooja V Shah
• Rachit Shah, DPM
• Soniya A Shah

• Psychiatric/Mental Health Clinical Nurse Specialist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.