Individual provider Active NPI

Charne Stoltz

  • Social Worker
  • Peoria, IL
National Provider Identifier
1821974015
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
5101 N Executive Dr
Peoria, IL 61614-4868
Phone
(309) 408-1493
NPI assigned
Aug 13, 2025
Last updated
Aug 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU Primary

Addresses

Primary practice location

5101 N Executive Dr
Peoria, IL 61614-4868

Mailing address

7802 W Smithville Rd
Peoria, IL 61607-9349
Phone (309) 857-3815

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251002003067 IL Practitioner - Clinical Social Worker 5698271120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5101 N Executive Dr
Peoria, IL 61614-4868

PO Box
Suite 833
Monroe, VA 24574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Edge Counseling and Wellness LLC CurrentSince Aug 1, 2025 Accepting new patients

Locations

5101 N Executive Dr
Peoria, IL 61614
Phone (309) 408-1493

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1755043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1821974015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7802 W SMITHVILLE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616079349",
            "telephone_number": "309-857-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 N EXECUTIVE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144868",
            "telephone_number": "309-408-1493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLTZ",
        "first_name": "CHARNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-13",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.