Individual provider Active NPI

Michael R Dantzer, MD

  • Pediatrics Physician
  • Yorkville, IL
National Provider Identifier
1124044474
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-082790 Issued in IL
Practice address
1500 Sycamore Rd
Suite 1000
Yorkville, IL 60560-1906
Phone
(630) 553-4470
NPI assigned
Jul 13, 2006
Last updated
May 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-082790 IL Primary

Addresses

Primary practice location

1500 Sycamore Rd
Suite 1000
Yorkville, IL 60560-1906

Mailing address

28594 Network PL
Chicago, IL 60673-1285

Other identifiers 1

IdentifierTypeStateIssuer
036082790MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mdantzer206508@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20040402000997 IL Practitioner - Pediatric Medicine 8123010550 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-082790ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients

Locations

1221 N Highland Ave
Aurora, IL 60506
Phone (630) 859-6700

2357 Sequoia Dr
Aurora, IL 60506
Phone (630) 859-6700

28594 Network Pl
Chicago, IL 60673

80 Templeton Dr
Oswego, IL 60543
Phone (630) 551-2760

1500 Sycamore Rd
#1000
Yorkville, IL 60560
Phone (630) 553-4470

Interoperability endpoints

  • Direct secure messaging: mdantzer206508@direct.myadvocateaurora.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1124044474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28594 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SYCAMORE RD",
            "address_2": "SUITE 1000",
            "city": "YORKVILLE",
            "state": "IL",
            "postal_code": "605601906",
            "telephone_number": "630-553-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANTZER",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-082790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082790",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdantzer206508@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Sycamore Rd",
            "address_2": "Suite 1000",
            "city": "Yorkville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605601906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1500 Sycamore Rd",
            "address_2": "Suite 1000",
            "city": "Yorkville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605601906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Yorkville, IL

Sources for this page

Verify at the official NPI Registry.