Active NPI
Dennis Wayne Dillard, C.PED., CTO
- Orthotic Fitter
- Peoria, IL
National Provider Identifier
1275667115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotic Fitter
- License
- 212-000127
- Practice address
- 741 W Main St
Peoria, IL 61606-2017 - Phone
- (309) 676-2276
- NPI assigned
- Mar 15, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | 212-000127 | IL | Primary |
Addresses
Primary practice location
741 W Main St
Peoria, IL 61606-2017
Mailing address
10823 W Smithville Rd
Hanna City, IL 61536-9711
Phone (309) 565-7133
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CPED1563 | Other | IL | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS, INC. |
| 212-000127 | Other | IL | STATE LICENSED PEDORTHIST |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 212-000127 | IL | MD | Orthotic Fitter |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352419200000",
"number": "1275667115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10823 W SMITHVILLE RD",
"city": "HANNA CITY",
"state": "IL",
"postal_code": "615369711",
"telephone_number": "309-565-7133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "741 W MAIN ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "616062017",
"telephone_number": "309-676-2276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLARD",
"first_name": "DENNIS",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "C.PED., CTO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2012-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": "IL",
"license": "212-000127",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS, INC.",
"identifier": "CPED1563",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSED PEDORTHIST",
"identifier": "212-000127",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.