Active NPI
Sarah Dutta, MD
- Obstetrics & Gynecology Physician
- Bloomington, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 036113555
- Practice address
- 1701 E College Ave
Bloomington, IL 61704-2101 - Phone
- (217) 383-3311
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 036113555 | IL | Primary |
Addresses
Primary practice location
1701 E College Ave
Bloomington, IL 61704-2101
Mailing address
602 W University Ave
Urbana, IL 61801-2530
Phone (217) 383-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IL2613 | Other | MEDICARE GROUP # |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Southern Illinois University School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
107 N Regency Dr
Suite 3
Bloomington, IL 61701-3505
Phone (309) 661-0406
Hospital & facility affiliations
- Northwestern Medicine Central Dupage Hospital
- St Joseph Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036113555 | IL | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sarah Dutta, OB-GYN, S.C. | Obstetrics & Gynecology | Current | Accepting new patients |
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
107 N Regency Dr
Ste 3
Bloomington, IL 61701
Phone (309) 661-0406
302 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 662-5361
1701 E College Ave
Bloomington, IL 61704
Phone (309) 664-3000
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
2500 W Reynolds St
#212
Pontiac, IL 61764
Phone (815) 842-3567
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EFHCCA/Endpoint/EFHCCA
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 and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Bloomington, IL
- NPI 1275975146
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Winfield, IL
- NPI 1003864810
-
- Psychiatric Hospital Unit
- Winfield, IL
- NPI 1740230895
-
- General Acute Care Hospital
- Bloomington, IL
- NPI 1619916806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258416000000",
"number": "1083648240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 W UNIVERSITY AVE",
"city": "URBANA",
"state": "IL",
"postal_code": "618012530",
"telephone_number": "217-383-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 E COLLEGE AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617042101",
"telephone_number": "217-383-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTTA",
"first_name": "SARAH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2009-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "IL",
"license": "036113555",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "IL2613",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.