NPIMap

Individual provider Active NPI

Stacie Laff, M.D.

  • Pediatrics Physician
  • Belleville, IL
National Provider Identifier
1851318489
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-092496 Issued in IL
Practice address
4600 Memorial Dr Ste 280
Belleville, IL 62226-5363
Phone
(618) 257-2800
Fax
(618) 257-9802
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-092496 IL Primary
Pediatrics Physician 208000000X 103954 MO

Addresses

Primary practice location

4600 Memorial Dr Ste 280
Belleville, IL 62226-5363

Mailing address

4600 Memorial Dr Ste 280
Belleville, IL 62226-5363
Phone (618) 257-2800

Other identifiers 2

IdentifierTypeStateIssuer
036092496-2MedicaidIL
036092496-3MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-092496ILMDPediatrics Physician
103954MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care St. Louis Pediatrics Past Accepting new patients
TLC Pediatrics LTS Pediatrics Past Accepting new patients
North County Emergency Physicians, LLP Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mandreozzi@kent.cernerdirect.carene.org

Organizations & group practices 3

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363564800000",
    "number": "1851318489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR STE 280",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265363",
            "telephone_number": "618-257-2800",
            "fax_number": "618-257-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR STE 280",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265363",
            "telephone_number": "618-257-2800",
            "fax_number": "618-257-9802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFF",
        "first_name": "STACIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-092496",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "103954",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092496-2",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092496-3",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.