Tracy Shadley, FNP is a medicare enrolled "Clinical Nurse Specialist - Psychiatric/mental Health" in Crystal Lake, Illinois. Her current practice location is
7220 Great Hill Rd, Crystal Lake, Illinois. You can reach out to her office (for appointments etc.) via phone at
(847) 999-8777.
Tracy Shadley is licensed to practice in Illinois (license number 277.001865) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1699263731.
Provider's Profile
| Full Name | Tracy Shadley |
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| Gender | Female |
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| Speciality | Clinical Nurse Specialist - Psychiatric/mental Health |
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| Location | 7220 Great Hill Rd, Crystal Lake, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1699263731
- Provider Enumeration Date: 04/24/2018
- Last Update Date: 12/12/2024
Medicare PECOS Information:
- PECOS PAC ID: 5991051658
- Enrollment ID: I20180711000089
Medical Identifiers
Medical identifiers for Tracy Shadley such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1699263731 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 277.001865 (Illinois) | Secondary |
| 364SP0808X | Clinical Nurse Specialist - Psychiatric/mental Health | 277.001865 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tracy Shadley allows following entities to bill medicare on her behalf.
| Entity Name | Glenwood Center, Ltd |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1003033861
PECOS PAC ID: 2567552441
Enrollment ID: O20071214000734 |
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| Entity Name | In Home Medical Group Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1497087175
PECOS PAC ID: 3779612395
Enrollment ID: O20100520000116 |
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| Entity Name | Chestnut Health Of Illinois Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1588043939
PECOS PAC ID: 2264747344
Enrollment ID: O20150819006369 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tracy Shadley is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Tracy Shadley, FNP
4215 Newburg Rd,
Rockford, IL 61108-6479
Ph: (815) 988-8500 | Tracy Shadley, FNP
7220 Great Hill Rd,
Crystal Lake, IL 60012-1637
Ph: (847) 999-8777 |
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