NPIMap

Individual provider Active NPI

Daniela Huerta de Hathaway, MD

  • Internal Medicine Physician
  • Crystal Lake, IL
National Provider Identifier
1235390154
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036127309 Issued in IL
Practice address
650 Dakota St Ste a
Crystal Lake, IL 60012
Phone
(815) 338-6600
Fax
(815) 356-1104
NPI assigned
Jun 23, 2008
Last updated
Oct 19, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125054385 IL
Internal Medicine Physician 207R00000X 036127309 IL Primary

Addresses

Primary practice location

650 Dakota St Ste a
Crystal Lake, IL 60012

Mailing address

650 Dakota St Ste a
Crystal Lake, IL 60012-3744
Phone (815) 338-6600

Other identifiers 3

IdentifierTypeStateIssuer
036127309OtherILSTATE LICENSE
P01069683OtherILRR MEDICARE PTAN
036127309MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110617000521 IL Practitioner - Internal Medicine 5294913463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

2900 Foxfield Rd
St Charles, IL 60174-5799

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036127309ILMDInternal Medicine Physician
125054385ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Internal Medicine CurrentSince May 1, 2019 Accepting new patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients
Northwest Medical Clinic SC Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

650 Dakota St
Ste A
Crystal Lake, IL 60012
Phone (815) 334-5018

11650 S State Route 47
Huntley, IL 60142
Phone (847) 802-7300

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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.

Hospital & facility affiliations 7

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": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1235390154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST STE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-338-6600",
            "fax_number": "815-356-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST STE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60012",
            "telephone_number": "815-338-6600",
            "fax_number": "815-356-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUERTA DE HATHAWAY",
        "first_name": "DANIELA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125054385",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036127309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036127309",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P01069683",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036127309",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.