NPIMap

Individual provider Active NPI

Dennis M Carroll, M.D.

  • Family Medicine Physician
  • Lincoln, IL
National Provider Identifier
1396838835
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-070375 Issued in IL
Practice address
100 Stahlhut Dr
Lincoln, IL 62656-5059
Phone
(217) 735-9555
NPI assigned
Oct 2, 2006
Last updated
May 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-070375 IL Primary

Addresses

Primary practice location

100 Stahlhut Dr
Lincoln, IL 62656-5059

Mailing address

1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541

Other identifiers 1

IdentifierTypeStateIssuer
036070375MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address denniscarroll@sfc.allscriptsdirect.net

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
I20060105000557 IL Practitioner - Family Practice 5395764583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

100 Stahlhut Dr
Lincoln, IL 62656-5059
Phone (217) 735-9555

1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541

200 Stahlhut Dr 1St Floor Room
Suite 428
Lincoln, IL 62656-5066
Phone (217) 605-5309

350 W Carpenter St
Springfield, IL 62702-4902
Phone (217) 525-0210

400 Saint Johns Dr
Sherman, IL 62684-9779
Phone (217) 525-4150

775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300

800 N 1St St
Springfield, IL 62702-3719
Phone (217) 528-7541

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as apm
Quality
75.65
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-070375ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic, LLP CurrentSince Feb 15, 2006 Accepting new patients

Locations

300 N Broad St
Carlinville, IL 62626
Phone (217) 544-2020

100 Stahlhut Dr
Lincoln, IL 62656
Phone (217) 735-9555

1025 S 6th St
Springfield, IL 62703

1025 S 7th St
Springfield, IL 62703
Phone (217) 525-7541

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

Interoperability endpoints

  • Direct secure messaging: dennis.carroll.1@28977.direct.athenahealth.com
  • Direct secure messaging: denniscarroll@sfc.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Clara's Rehab & Senior CareLincoln, IL, CCN 145720 Skilled nursing facility Corporate Director
Operational/Managerial Control
Adp of the SNF		 Nov 8, 2016
Nov 8, 2016
Nov 8, 2016
Springfield Clinic Lincoln Rural HealthLincoln, IL, CCN 143925 Rural health clinic Limited Partnership Interest Jan 1, 1996
Springfield Clinic Nokomis Rural HealthNokomis, IL, CCN 783814 Rural health clinic Limited Partnership Interest Jan 1, 1996
Springfield Clinic Raymond Rural HealthRaymond, IL, CCN 783829 Rural health clinic Limited Partnership Interest Jan 1, 1996
Springfield Clinic Neoga Rural HealthNeoga, IL, CCN 783812 Rural health clinic Limited Partnership Interest Jan 1, 1996
Springfield Clinic, LLPMacomb, IL, CCN 783855 Rural health clinic Limited Partnership Interest Jan 1, 1996

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 9

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1396838835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541",
            "fax_number": "217-528-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STAHLHUT DR",
            "city": "LINCOLN",
            "state": "IL",
            "postal_code": "626565059",
            "telephone_number": "217-735-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "DENNIS",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-070375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036070375",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "denniscarroll@sfc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "100 Stahlhut Dr",
            "city": "Lincoln",
            "state": "IL",
            "country_code": "US",
            "postal_code": "626565059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln, IL

Sources for this page

Verify at the official NPI Registry.