TRACY DOUGLAS (NPI# 1053822072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053822072 |
| Entity Type | Individual |
| Full Name | TRACY DOUGLAS |
| Practice Address |
19530 Kedzie Ave Flossmoor IL 60422-1778 |
| Mailing Address |
17746 Oak Park Ave Tinley Park IL 60477-3936 |
| Practice Telephone | 7087992200 |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396346078 | Tracy Lee Douglas | Pharmacist | 3220 Irvin Cobb Dr, Paducah, KY 42003-2196 | 2020-11-08 |
| 1275909954 | Tracy Douglas | Social Worker | 2479 Aloma Ave, Winter Park, FL 32792-2541 | 2015-08-17 |
| 1396152609 | Tracy Douglas | Social Worker | 96 South St, Ware, MA 01082-1616 | 2014-07-18 |
| Street Address |
19530 KEDZIE AVE |
| City | FLOSSMOOR |
| State | IL |
| Zip Code | 60422-1778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194763433 | Andrea Bacon | Psychiatry & Neurology | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2006-06-02 |
| 1508470048 | Kristen Efantis | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2020-09-02 |
| 1225642762 | Shannon Ristedt | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2020-09-02 |
| 1548874241 | Amani Davis | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2020-09-01 |
| 1487291738 | Carole Holliday | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-12-05 |
| 1366089625 | Rolanda Bailey-clark | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-12-05 |
| 1841840360 | Sarah Seebold | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-09-17 |
| 1477103992 | Kathryn Panzica | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-09-17 |
| 1003466533 | Sotira Vamvouris | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-09-17 |
| 1811547342 | Shawna Brough | Counselor | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2019-09-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274310 | Miranda Home Health Care Inc | Nursing Care | 19150 S. Kedzie Ave, 203, Flossmoor, IL 60422 | 2020-08-06 |
| 1285256172 | Bp Behavioral Services, LLC | Behavioral Analyst | 2222 Marston Lane, Flossmoor, IL 60422 | 2020-05-13 |
| 1891164133 | Lauren Simpson | Behavioral Analyst | 19530 Kezie Avenue, Flossmoor, IL 60422 | 2015-09-16 |
| 1437541190 | Keshawn Gardner | Specialist/Technologist, Other | 1248 Berry Ln, Flossmoor, IL 60422 | 2015-03-04 |
| 1770989717 | Naomi Kelly | Behavioral Analyst | 1930 Kedzie Avenue, Flossmoor, IL 60422 | 2014-11-18 |
| 1093059453 | Miranda Home Health Care Inc | In Home Supportive Care | 19150 S Kedzie Ave, 203, Flossmoor, IL 60422 | 2012-11-23 |
| 1285981506 | Restorative Life Services, LLC | Social Worker | 169624 Governors Highway, Flossmoor, IL 60422 | 2012-08-06 |
| 1063786457 | Gwyneeda Carter-sidberry | Pharmacist | 1443 Selkirk Street, Flossmoor, IL 60422 | 2012-03-02 |
| 1053682021 | Alfonso Javier Medina Sr. | Anesthesiology | 3141 Stonegate Ct., Flossmoor, IL 60422 | 2012-01-23 |
| 1912121161 | Anthony J Maoloni | Dentist | 19815 Governors Highway, Orthodontic Associates Ltd Suite 1, Flossmoor, IL 60422 | 2007-04-12 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043794712 | Lindsey Beham | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2018-09-19 |
| 1508377516 | Ashley Kendrick | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2017-10-17 |
| 1649798497 | Kelsey Berry | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2017-08-31 |
| 1710405568 | Lindsay Hathaway | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2017-08-31 |
| 1083132831 | Kara Mayer | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2017-08-31 |
| 1851811335 | Felicia Lewis | Case Manager/Care Coordinator | 19530 Kedzie Ave, Flossmoor, IL 60422-1778 | 2017-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740887157 | Forefront Healthcare Solutions, Inc. | Case Manager/Care Coordinator | 60 E Monroe St Unit 3801, Chicago, IL 60603-2751 | 2020-10-08 |
| 1205441698 | Desirae Mccrainey | Case Manager/Care Coordinator | 55 E Monroe St Ste 38109, Chicago, IL 60603-5713 | 2020-09-11 |
| 1871119966 | Nimble Corporation | Case Manager/Care Coordinator | 28369 Davis Pkwy Ste 403, Warrenville, IL 60555-3036 | 2020-06-24 |
| 1659993954 | Aubrey Williams | Case Manager/Care Coordinator | 1533 W Warren Blvd, Chicago, IL 60607-1852 | 2020-05-11 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1720616063 | Amber Lynn Gille | Case Manager/Care Coordinator | 13262 Foxglove Ln, Winnebago, IL 61088-9012 | 2020-03-31 |
| 1467084897 | Lisa S Johnson | Case Manager/Care Coordinator | 510 Exeter Pl, Lake Forest, IL 60045-1521 | 2020-02-04 |
| 1073158085 | Danny Living | Case Manager/Care Coordinator | 1050 Freemont St, Yorkville, IL 60560-2074 | 2019-11-13 |
| 1235772864 | Rebekah Johnson | Case Manager/Care Coordinator | 208 E 87th St, Chicago, IL 60619-6040 | 2019-10-27 |
| 1558903161 | Isadora Borrero | Case Manager/Care Coordinator | 1850 W Highland Ave # F101, Elgin, IL 60123-5095 | 2019-10-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.