Individual provider Active NPI

Clyde W. Dayhoff Jr., DO

  • Family Medicine Physician
  • Herscher, IL
National Provider Identifier
1255417382
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
692 N Maple St
Herscher, IL 60941
Phone
(815) 426-2020
NPI assigned
Oct 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IL Primary

Addresses

Primary practice location

692 N Maple St
Herscher, IL 60941

Mailing address

555 W Court St Ste 410
Kankakee, IL 60901-3675
Phone (815) 937-2284

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
I20100220000403 IL Practitioner - Family Practice 8426957119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Group of Kankakee CountyGroup PAC ID 3577462258, 7 clinicians

Practice addresses (Care Compare)

555 E N St
Suite E
Bradley, IL 60915-1232
Phone (815) 929-0858

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-096344ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Group of Kankakee County Family Medicine CurrentSince Jan 1, 2002 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Presence Service Corporation Family Medicine Past Accepting new patients

Locations

555 E North St
Ste E
Bradley, IL 60915
Phone (815) 929-0858

692 N Maple St
Herscher, IL 60941
Phone (815) 426-2020

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 6

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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255417382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W COURT ST STE 410",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013675",
            "telephone_number": "815-937-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 N MAPLE ST",
            "city": "HERSCHER",
            "state": "IL",
            "postal_code": "60941",
            "telephone_number": "815-426-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAYHOFF",
        "first_name": "CLYDE",
        "middle_name": "W.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herscher, IL

Sources for this page

Verify at the official NPI Registry.