Individual provider Active NPI

Penny M Dale, APRN

  • Family Nurse Practitioner
  • Willowbrook, IL
National Provider Identifier
1316673197
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209022145 Issued in IL
Practice address
40 75TH St
Willowbrook, IL 60527-2325
Phone
(512) 734-9003
NPI assigned
Jul 25, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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 209.022145 IL
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 209022145 IL Primary

Addresses

Primary practice location

40 75TH St
Willowbrook, IL 60527-2325

Mailing address

40 75TH St
Willowbrook, IL 60527-2325
Phone (512) 734-9003

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
I20220831003334 IL Practitioner - Nurse Practitioner 4486038924 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

1420 Busse Rd
Elk Grove Village, IL 60007-5324
Phone (847) 653-0142

1690 W Lake St
Addison, IL 60101-1833
Phone (630) 283-6633

226 S Randall Rd
Algonquin, IL 60102-9775
Phone (224) 442-3000

29 N Northwest Hwy
Palatine, IL 60067-5322
Phone (847) 931-5555

405 W Golf Rd
Schaumburg, IL 60195-3501
Phone (224) 215-0011

4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000

4900 N Cumberland Ave
Norridge, IL 60706-2901
Phone (708) 456-1600

7425 Barrington Rd
Hanover Park, IL 60133-2241
Phone (630) 823-0392

8630 W Golf Rd
Niles, IL 60714-5600
Phone (847) 299-0009

901 E Rand Rd
Mount Prospect, IL 60056-2580
Phone (708) 675-7966

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.022145ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc Single Specialty CurrentSince Jul 25, 2022 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jul 25, 2022 Accepting new patients
Physicians Immediate Care North Chicago LLC Single Specialty CurrentSince Jan 8, 2024 Accepting new patients

Locations

2070 N State Route 50
Ste 500
Bourbonnais, IL 60914
Phone (779) 236-4094

800 W Fulton Market
Fl 12
Chicago, IL 60607

4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000

9501 S Western Ave
Chicago, IL 60643
Phone (773) 344-9465

13448 Cicero Ave
Crestwood, IL 60418
Phone (708) 682-3384

7425 Barrington Rd
Hanover Park, IL 60133
Phone (630) 823-0392

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Organizations & group practices 4

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": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1316673197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "512-734-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "512-734-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "PENNY",
        "middle_name": "M",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022145",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

Verify at the official NPI Registry.