NPIMap

Individual provider Active NPI

Nicole Dalton, P.A.

  • Physician Assistant
  • Forsyth, IL
National Provider Identifier
1326109992
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-001647 Issued in IL
Practice address
241 W Weaver Rd
Suite 145B
Forsyth, IL 62535-9762
Phone
(217) 794-5472
Fax
(217) 794-5458
NPI assigned
Dec 13, 2006
Last updated
Apr 28, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-001647 IL Primary

Addresses

Primary practice location

241 W Weaver Rd
Suite 145B
Forsyth, IL 62535-9762

Mailing address

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-2868

Other identifiers 3

IdentifierTypeStateIssuer
833120OtherMEDICARE GROUP #
CA2264OtherRR GROUP #
P00807365OtherRR INDIVIDUAL #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040525001501 IL Practitioner - Physician Assistant 6608857792 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

1231 Kleemann Dr
Clinton, IL 61727-2633
Phone (217) 935-5022

2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-001647ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Dec 1, 2022 Accepting new patients
Saint James Hospital CurrentSince Dec 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Saint James Hospital Past Accepting new patients

Locations

1231 Kleemann Dr
Clinton, IL 61727
Phone (217) 784-2240

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

Organizations & group practices 7

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 5

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272412800000",
    "number": "1326109992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-2868",
            "fax_number": "217-876-2874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 W WEAVER RD",
            "address_2": "SUITE 145B",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359762",
            "telephone_number": "217-794-5472",
            "fax_number": "217-794-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALTON",
        "first_name": "NICOLE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2010-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-001647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "833120",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP #",
            "identifier": "CA2264",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR INDIVIDUAL #",
            "identifier": "P00807365",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forsyth, IL

Sources for this page

Verify at the official NPI Registry.