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  7. NPI Record 1578576823

LAURA L PEDELTY PHD, MD
Complete NPI Record 1578576823
Psychiatry & Neurology - Neurology in Chicago, IL

NPI Status: Active since August 15, 2006

Contact Information

1740 W TAYLOR ST
CHICAGO, IL
ZIP 60612
Phone: (866) 600-2273

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Provider Gender Code
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1578576823. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1578576823
The first name of the provider, if the provider is an individual.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: LAURA
The first name of the provider, if the provider is an individual.
Provider Middle Name: L
The middle name of the provider, if the provider is an individual.
Provider Credential Text: PHD, MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 1000 REMINGTON BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: STE 100
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: BOLINGBROOK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: IL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 604404707
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6309142401
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6309142469
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Practice Location Address: 1740 W TAYLOR ST
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address City Name: CHICAGO
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address State Name: IL
The date that a record was last updated or changed.
Provider Business Practice Location Address Postal Code: 606127232
The code designating the provider’s gender if the provider is a person.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8666002273
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/15/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/13/2017
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 2084N0400X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 036-086820
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: IL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No