Active NPI
Thomas J Danaher, MD
- Orthopaedic Surgery Physician
- Rockford, IL
National Provider Identifier
1114994845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 036056019
- Practice address
- 1340 Charles St
Ste 100
Rockford, IL 61104 - Phone
- (779) 696-1900
- NPI assigned
- Mar 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 036056019 | IL | Primary |
Addresses
Primary practice location
1340 Charles St
Ste 100
Rockford, IL 61104
Mailing address
PO Box 1567
Rockford, IL 61110-0067
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036056019 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036056019 | IL | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435708800000",
"number": "1114994845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1567",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611100067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 CHARLES ST",
"address_2": "STE 100",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "61104",
"telephone_number": "779-696-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANAHER",
"first_name": "THOMAS",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-01",
"last_updated": "2015-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "IL",
"license": "036056019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036056019",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.