Individual provider Active NPI

Joseph Dalton, PA-C

  • Physician Assistant
  • Libertyville, IL
National Provider Identifier
1053938167
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone
(847) 816-6335
NPI assigned
Jul 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312

Mailing address

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone (847) 816-6335

Other practice location 1

1203 W Augusta Blvd Unit 1
Chicago, IL 60642-4327
Phone (773) 248-2255

Other practice location 2

1431 N 53rd St
Milwaukee, WI 53208-2227
Phone (608) 214-9221

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
I20210907002223 IL Practitioner - Physician Assistant 9739585316 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ganesha Institute of Neurology and Psychiatry SCGroup PAC ID 0042432296, 25 clinicians

Practice addresses (Care Compare)

1860 W Winchester Rd
Suite 106
Libertyville, IL 60048-5312
Phone (847) 816-6335

Hospital & facility affiliations

  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ganesha Institute of Neurology and Psychiatry SC Physician Assistant CurrentSince Sep 14, 2022 Accepting new patients
Bespoke Psychiatry CurrentSince Jul 1, 2021 Accepting new patients
Ganesha Institute of Neurology and Psychiatry SC Physician Assistant CurrentSince Sep 14, 2022 Accepting new patients

Locations

1203 W Augusta Blvd
Ste 1
Chicago, IL 60642
Phone (773) 248-2255

1850 W Winchester Rd
Ste 115
Libertyville, IL 60048
Phone (847) 816-6335

1860 W Winchester Rd
Ste 106
Libertyville, IL 60048
Phone (847) 599-0715

Interoperability endpoints

  • Direct secure messaging: joe.dalton.1@9664.direct.athenahealth.com

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 3

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": "1593993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1053938167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD STE 106",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485312",
            "telephone_number": "847-816-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD STE 106",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485312",
            "telephone_number": "847-816-6335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1203 W Augusta Blvd Unit 1",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606424327",
            "country_code": "US",
            "telephone_number": "773-248-2255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1431 N 53rd St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532082227",
            "country_code": "US",
            "telephone_number": "608-214-9221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALTON",
        "first_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-06",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.