Dekalb Clinic Chartered

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DEKALB CLINIC CHARTERED

Practice address

1850 Gateway Dr
Sycamore, IL 60178-3192

Phone

(815) 758-8671

Fax

(815) 758-5610

NPI assigned

Jul 17, 2006

Last updated

Apr 30, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roger L Haab, M.D.NPI 1386653517

Title

Chairman, Board of Directors

Phone

(815) 758-8671

Specialties & licenses 15

Addresses

Other identifiers 4

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Northern Illinois Imaging Specialists LLC

  • Nuclear Medicine Physician
  • Dekalb, IL
  • NPI 1487680765

  Member Of

  NPD member

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Haab, M.D.

  • Internal Medicine Physician
  • Sycamore, IL
  • NPI 1386653517
  Authorized official Same address or phone
• Peter Baum, M.D.

  • Allergy Physician
  • Sycamore, IL
  • NPI 1164431391
  NPD
• James Kolar, M.D.

  • General Practice Physician
  • Sycamore, IL
  • NPI 1548279771
  NPD
• Ilaxi Patel, D.O.

  • Internal Medicine Physician
  • Sycamore, IL
  • NPI 1629087861
  NPD
• Roger Maillefer, M.D.

  • Surgery Physician
  • Charlevoix, MI
  • NPI 1558373696
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1447277140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 GATEWAY DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783192",
            "telephone_number": "815-758-8671",
            "fax_number": "815-758-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 GATEWAY DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783192",
            "telephone_number": "815-758-8671",
            "fax_number": "815-758-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB CLINIC CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "HAAB",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN, BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "815-758-8671",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036119759",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036120383",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016-005282",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "14D0415284",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC INDEPENDENT LAB",
            "identifier": "148547",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1421279",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-GROUP ID",
            "identifier": "663680",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Matthew Dailey, M.A., LPC, NCC
• Christine M Davis, MS, BCBA
• Eva De Coro, LMT
• Ricardo Manuel De Oliveira Soares, MD. FEBU
• Joseph C Dearie, MD
• Dekalb Clinic Chartered
• Dekalb Eye Consultants, LLC (Arlington Eye Physicians)
• Dekalb Hearing Services, LLC (Hauser-Ross Hearing Services)
• Dekalb Medical Clinic,Inc (Dekalb Internal Medicine)
• Dekalb Optical Shop LLC (Hauser-Ross Optical)

• Internal Medicine Physician in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.