Active NPI
Jeffrey Richard Dahlen, M.D.
- Emergency Medicine Physician
- Urbana, IL
National Provider Identifier
1265680144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 036.167523
- Practice address
- 1109 S Lincoln Ave
Urbana, IL 61801-4703 - Phone
- (217) 333-2700
- NPI assigned
- Sep 3, 2008
- Last updated
- Dec 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 52429 | MN | |
| Pediatric Emergency Medicine (Emergency Medicine) Physician | 207PP0204X | 52429 | MN | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 036.167523 | IL | |
| Emergency Medicine Physician | 207P00000X | 036.167523 | IL | Primary |
Addresses
Primary practice location
1109 S Lincoln Ave
Urbana, IL 61801-4703
Mailing address
1109 S Lincoln Ave
Urbana, IL 61801-4703
Other practice location 1
2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6843
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52429 | MN | MD | Pediatric Emergency Medicine (Emergency Medicine) Physician |
| 036.167523 | IL | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1265680144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1109 S LINCOLN AVE",
"city": "URBANA",
"state": "IL",
"postal_code": "618014703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 S LINCOLN AVE",
"city": "URBANA",
"state": "IL",
"postal_code": "618014703",
"telephone_number": "217-333-2700"
}
],
"practiceLocations": [
{
"address_1": "2525 Chicago Ave",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "55404",
"country_code": "US",
"telephone_number": "612-813-6843",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAHLEN",
"first_name": "JEFFREY",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-03",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MN",
"license": "52429",
"primary": false
},
{
"code": "207PP0204X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Pediatric Emergency Medicine",
"state": "MN",
"license": "52429",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "IL",
"license": "036.167523",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036.167523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.