Wade M Stark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180013660 Issued in IL

Practice address

626 W Lincoln Ave
Charleston, IL 61920-2444

Phone

(217) 345-7702

Fax

(217) 345-7705

NPI assigned

Nov 1, 2019

Sex

Male

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Illinois Healthcare Foundation IncGroup PAC ID 1456256874, 117 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wade.stark.p32@direct.fhn-fqhc.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: wade.stark.1@9559.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 and National Provider Directory roles.

• Southern Illinois Healthcare Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500
  Medicare reassignment Care Compare group NPD
• Douglas County

  • Public Health or Welfare Agency
  • Tuscola, IL
  • NPI 1659406163
  NPD
• Douglas County

  • Public Health or Welfare Agency
  • Tuscola, IL
  • NPI 1912601204
  NPD
• Southern Illinois Healthcare Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD
• Southern Illinois Healthcare Foundation, Inc.

  • Federally Qualified Health Center (FQHC)
  • Vandalia, IL
  • NPI 1326288143

  Professional

  NPD

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

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1801430988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 W LINCOLN AVE",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202444",
            "telephone_number": "217-345-7702",
            "fax_number": "217-345-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 W LINCOLN AVE",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202444",
            "telephone_number": "217-345-7702",
            "fax_number": "217-345-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "WADE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-01",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180013660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ginger Candice South, ATC
• Southern Illinois Healthcare Foundation, Inc.
• Jordan Spencer, DDS
• Mary Jean Stanley
• Haveliah Stark, LMT
• Jennifer Lynn Staskiewicz, ATC
• Stephen L. Hutti & Mark E. Hutti PTR
• Gabrielle Celeste Stice
• David W Stoltz, MD
• Storyteller'S Counseling Services, LLC

• Mental Health Counselor in Charleston, IL
• Providers in Charleston, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; 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.