Active NPI
Daniel R Herdeman, MD
- Internal Medicine Physician
- Rockford, IL
National Provider Identifier
1447293451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036081171
- Practice address
- 3505 North Bell School Road
Rockford, IL 61114 - Phone
- (779) 696-0300
- NPI assigned
- Jun 14, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036081171 | IL | Primary |
Addresses
Primary practice location
3505 North Bell School Road
Rockford, IL 61114
Mailing address
PO Box 1567
Rockford, IL 61110-0067
Other practice location 1
3775 N Mulford Rd
Rockford, IL 61114
Phone (779) 696-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036081171 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dherdeman911628@direct.uwhealth.org |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036081171 | IL | MD | Internal Medicine Physician |
Interoperability endpoints
- njina1247123@direct.uwhealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613692800000",
"number": "1447293451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1567",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611100067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 NORTH BELL SCHOOL ROAD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "61114",
"telephone_number": "779-696-0300"
}
],
"practiceLocations": [
{
"address_1": "3775 N Mulford Rd",
"address_purpose": "LOCATION",
"city": "Rockford",
"state": "IL",
"postal_code": "61114",
"country_code": "US",
"telephone_number": "779-696-8400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HERDEMAN",
"first_name": "DANIEL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2021-02-19",
"certification_date": "2021-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036081171",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036081171",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dherdeman911628@direct.uwhealth.org",
"affiliation": "N",
"address_1": "3505 North Bell School Road",
"city": "Rockford",
"state": "IL",
"country_code": "US",
"postal_code": "61114",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.