Individual provider Active NPI

Laura L Dagdick, CNP

  • Family Nurse Practitioner
  • Crystal Lake, IL
National Provider Identifier
1255689543
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209009741 Issued in IL
Practice address
650 Dakota St Ste a
Crystal Lake, IL 60012-3744
Phone
(815) 455-6000
Fax
(815) 356-1104
NPI assigned
Aug 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209009741 IL Primary
Nurse Practitioner 363L00000X 209009741 IL

Addresses

Primary practice location

650 Dakota St Ste a
Crystal Lake, IL 60012-3744

Mailing address

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

Other practice location 1

2507 N Richmond Rd
McHenry, IL 60051-5407
Phone (815) 338-6600

Other practice location 2

3707 Doty Rd Ste G
Woodstock, IL 60098-7530
Phone (815) 338-6600

Other practice location 3

3707 Doty Rd Ste H
Woodstock, IL 60098-7530
Phone (815) 338-6600

Other practice location 4

10350 Haligus Rd Ste 200
Huntley, IL 60142-9545
Phone (815) 338-6600

Other practice location 5

10350 Haligus Rd
Huntley, IL 60142-9545
Phone (815) 338-6600

Other practice location 6

1925 Huntley Rd
West Dundee, IL 60118-9301
Phone (815) 338-6600

Other practice location 7

360 Station Dr
Crystal Lake, IL 60014-7978
Phone (815) 338-6600

Other practice location 8

2507 N Richmond Rd
McHenry, IL 60051-5407
Phone (815) 338-6600

Other identifiers 1

IdentifierTypeStateIssuer
209009741OtherILSTATE LICENSE

Other names 1

  • Laura L Graves Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121206000579 IL Practitioner - Nurse Practitioner 4284886730 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209009741ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

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

360 Station Dr
Crystal Lake, IL 60014
Phone (815) 477-7350

650 Dakota St
Crystal Lake, IL 60012
Phone (815) 455-6000

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

10350 Haligus Rd
Ste 200
Huntley, IL 60142

10350 Haligus Rd
Huntley, IL 60142
Phone (847) 802-7150

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

2507 N Richmond Rd
McHenry, IL 60051
Phone (815) 363-2350

1925 Huntley Rd
West Dundee, IL 60118
Phone (847) 854-3421

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

3707 Doty Rd
Ste G
Woodstock, IL 60098
Phone (815) 334-5018

3707 Doty Rd
Ste H
Woodstock, IL 60098
Phone (847) 981-3677

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.

NPI Registry JSON

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1255689543",
    "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": "600123744",
            "telephone_number": "815-455-6000",
            "fax_number": "815-356-1104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2507 N Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600515407",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-759-4078",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3707 Doty Rd Ste G",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987530",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-337-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3707 Doty Rd Ste H",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987530",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-337-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 Haligus Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429545",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-669-2980",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429545",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-802-7112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1925 Huntley Rd",
            "address_purpose": "LOCATION",
            "city": "West Dundee",
            "state": "IL",
            "postal_code": "601189301",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-426-5162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Station Dr",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147978",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-455-8044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2507 N Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600515407",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-385-3255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAGDICK",
        "first_name": "LAURA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-17",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209009741",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209009741",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "209009741",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "GRAVES",
            "middle_name": "L",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.