Individual provider Active NPI

Dhara Mehta

  • Family Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1003505314
Registry record updated Jul 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.029582 Issued in IL
Practice address
6861 Villagreen VW
Rockford, IL 61107-5639
Phone
(779) 696-0250
NPI assigned
May 3, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.497979 IL
Family Nurse Practitioner 363LF0000X 209.029582 IL Primary

Addresses

Primary practice location

6861 Villagreen VW
Rockford, IL 61107-5639

Mailing address

6861 Villagreen VW
Rockford, IL 61107-5639

Other identifiers 1

IdentifierTypeStateIssuer
236MedicaidDC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250310000673 IL Practitioner - Nurse Practitioner 6002337847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1700 Henry Luckow LN
Belvidere, IL 61008-1702
Phone (779) 696-8650

2909 N Main St
Rockford, IL 61103-3100
Phone (779) 696-5000

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

815 Marchesano Dr
Rockford, IL 61102-3521
Phone (779) 696-5950

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041.497979ILMDRegistered Nurse
209.029582ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital Current Accepting new patients
Swedishamerican Hospital CurrentSince Mar 4, 2025 Accepting new patients
Swedishamerican Hospital CurrentSince Mar 4, 2025 Accepting new patients

Locations

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

6861 Villagreen Vw
Rockford, IL 61107
Phone (779) 696-0250

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IL PPO Downstate
  • IL HMO C-SNP

Organizations & group practices 3

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752278400000",
    "number": "1003505314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6861 VILLAGREEN VW",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6861 VILLAGREEN VW",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075639",
            "telephone_number": "779-696-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "DHARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-03",
        "last_updated": "2025-07-12",
        "certification_date": "2025-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.497979",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.029582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.