Individual provider Active NPI

Daniel Robert Bamrick-Fernandez, MD, MBA

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1063113678
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
125.084285 Issued in IL
Practice address
1801 W Taylor St
Chicago, IL 60612-4795
Phone
(312) 996-0106
NPI assigned
Mar 13, 2023
Last updated
Jul 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 125.084285 IL Primary

Addresses

Primary practice location

1801 W Taylor St
Chicago, IL 60612-4795

Mailing address

808 S Wood St Ste 380
Chicago, IL 60612-7300
Phone (312) 413-7767

Other names 1

  • Mr. Daniel Robert Bamrick Jr. Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250612000411 IL Order and Referring Only - DermatologyPractitioner - Dermatology 4486164084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.084285ILMDDermatology Physician

Interoperability endpoints

  • Direct secure messaging: dbamrickfernandez188809@uihealth.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1063113678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 S WOOD ST STE 380",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127300",
            "telephone_number": "312-413-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-996-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAMRICK-FERNANDEZ",
        "first_name": "DANIEL",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "125.084285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIEL",
            "last_name": "BAMRICK",
            "middle_name": "ROBERT",
            "prefix": "MR.",
            "suffix": "JR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.