NPIMap

Individual provider Active NPI

Dana L Altenburger, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Normal, IL
National Provider Identifier
1003067661
Registry record updated Sep 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036.127294 Issued in IL
Practice address
1304 Franklin Ave
Normal, IL 61761-3558
Phone
(309) 268-2657
NPI assigned
Oct 1, 2008
Last updated
Sep 10, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036.127294 IL Primary

Addresses

Primary practice location

1304 Franklin Ave
Normal, IL 61761-3558

Mailing address

2163 W Ravina Park Rd
Decatur, IL 62526-3067
Phone (309) 268-2657

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110719000740 IL Practitioner - Pathology 3577731421 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Northeastern Ohio University College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
K M B S CGroup PAC ID 1951365303, 3 clinicians

Practice addresses (Care Compare)

1304 Franklin Ave
Normal, IL 61761-3558
Phone (309) 268-5128

422 W White St
Clinton, IL 61727-2272
Phone (217) 935-9571

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.127294ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Clinton Current Accepting new patients
K M B S C Anatomic Pathology & Clinical Pathology CurrentSince Jul 11, 2011 Accepting new patients

Locations

422 W White St
Clinton, IL 61727
Phone (217) 935-9570

1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378771200000",
    "number": "1003067661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2163 W RAVINA PARK RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263067",
            "telephone_number": "309-268-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FRANKLIN AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613558",
            "telephone_number": "309-268-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTENBURGER",
        "first_name": "DANA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2013-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036.127294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.