Active NPI
Richard Clarence Stalzer
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1891915138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Practice address
- 30 West Chicago Ave
Suite 312
Chicago, IL 60610-4331 - Phone
- (312) 926-3964
- Fax
- (312) 926-3028
- NPI assigned
- Apr 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | IL | Primary |
Addresses
Primary practice location
30 West Chicago Ave
Suite 312
Chicago, IL 60610-4331
Mailing address
86 West Canterbury LN
Northfield, IL 60093-3110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 11, 2016 through May 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ILL 036039351 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891915138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 WEST CANTERBURY LN",
"city": "NORTHFIELD",
"state": "IL",
"postal_code": "600933110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 WEST CHICAGO AVE",
"address_2": "SUITE 312",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606104331",
"telephone_number": "312-926-3964",
"fax_number": "312-926-3028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALZER",
"first_name": "RICHARD",
"middle_name": "CLARENCE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.