Individual provider Active NPI

Daniel Bommelje, D.O.

  • Emergency Medicine Physician
  • Mattoon, IL
National Provider Identifier
1245346691
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-093246 Issued in IL
Practice address
1000 Health Center Dr
Mattoon, IL 61938-9261
Phone
(217) 258-2551
Fax
(217) 258-2256
NPI assigned
Aug 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-093246 IL Primary

Addresses

Primary practice location

1000 Health Center Dr
Mattoon, IL 61938-9261

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

2040 Lincoln Ave Ste 100
Charleston, IL 61920-3197
Phone (217) 345-2030

Other practice location 2

1100 Tuscola Blvd
Tuscola, IL 61953-2065
Phone (217) 253-4764

Other practice location 3

1201 Wooddell Way Ste B
Mattoon, IL 61938-1014
Phone (217) 238-3000

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
I20100108000680 IL Practitioner - Emergency Medicine 1355482662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644
Phone (217) 258-2525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-093246ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Jul 1, 1998 Accepting new patients

Locations

2040 Lincoln Ave
Ste 100
Charleston, IL 61920
Phone (217) 345-2030

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1201 Wooddell Way
Ste B
Mattoon, IL 61938
Phone (217) 238-3000

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1100 Tuscola Blvd
Tuscola, IL 61953
Phone (217) 253-2020

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1245346691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389261",
            "telephone_number": "217-258-2551",
            "fax_number": "217-258-2256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2040 Lincoln Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "IL",
            "postal_code": "619203197",
            "country_code": "US",
            "telephone_number": "217-345-2030",
            "fax_number": "217-345-2045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Tuscola Blvd",
            "address_purpose": "LOCATION",
            "city": "Tuscola",
            "state": "IL",
            "postal_code": "619532065",
            "country_code": "US",
            "telephone_number": "217-253-4764",
            "fax_number": "217-253-4886",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Wooddell Way Ste B",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619381014",
            "country_code": "US",
            "telephone_number": "217-238-3000",
            "fax_number": "217-238-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOMMELJE",
        "first_name": "DANIEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-093246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.