Stacie Chambliss, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070016676 Issued in IL

Practice address

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262

Phone

(618) 242-3778

Fax

(618) 242-2551

NPI assigned

Sep 8, 2008

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

Other names 1

• Stacie Minor Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

79.43 of 100Reported as group

Quality

59.68

Promoting interoperability

92

Improvement activities

40

Cost

72.02

Medicare enrollment (NPD)

Enrolled

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.

• Empowerme Rehabilitation Illinois, LLC

  • Occupational Therapist
  • Edwardsville, IL
  • NPI 1679098263

  Physical Therapist

  Medicare reassignment NPD
• Orthopaedic Center of Southern Illinois, LTD.

  • Orthopaedic Surgery Physician
  • Mount Vernon, IL
  • NPI 1134171226
  Medicare reassignment NPD
• Empowerme Rehabilitation Illinois, LLC

  • Rehabilitation Clinic/Center
  • Mount Carmel, IL
  • NPI 1962073734

  Physical Therapist

  NPD
• Orthopaedic Center of Southern Illinois, LTD.

  • Orthopaedic Surgery Physician
  • Centralia, IL
  • NPI 1932432143
  NPD

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274832000000",
    "number": "1780832253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-3778",
            "fax_number": "618-242-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-3778",
            "fax_number": "618-242-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBLISS",
        "first_name": "STACIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-08",
        "last_updated": "2010-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070016676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIE",
            "last_name": "MINOR",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Care Medical Supplies Inc
• Stacie Lynn Carr, LCSW
• Juan Alfredo Carrillo, MD
• Amy Jo Cates, LCSW
• Catholic Social Services Mt. Vernon
• Jenny Charlton, O.T.
• Rebecca Chavez
• Hitanshu Chawla, M.D.
• Ismat Cheema, DO
• Henry H Chen, M.D.

• Physical Therapist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.