Clifton Shavar Stewart, RSA

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

11560 S Kedzie Ave
Merrionette Park, IL 60803-4517

Phone

(708) 914-5800

NPI assigned

Jul 21, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1962182154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11560 S KEDZIE AVE",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608034517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11560 S KEDZIE AVE",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608034517",
            "telephone_number": "708-914-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11560 S Kedzie Ave",
            "address_purpose": "LOCATION",
            "city": "Merrionette Park",
            "state": "IL",
            "postal_code": "608034517",
            "country_code": "US",
            "telephone_number": "708-914-5800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWART",
        "first_name": "CLIFTON",
        "middle_name": "SHAVAR",
        "credential": "RSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-21",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Merrionette Park, IL
• Providers in Merrionette Park, IL by specialty
• Peer Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.