NPIMap

Individual provider Active NPI

Phong Dao Lam Dang, M.D.

  • Family Medicine Physician
  • Sterling, IL
National Provider Identifier
1447394465
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.117094 Issued in IL
Practice address
100 E Lefevre Rd
Sterling, IL 61081-1278
Phone
(815) 625-0400
Fax
(815) 625-6728
NPI assigned
Feb 16, 2007
Last updated
Jul 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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 036.117094 IL Primary

Addresses

Primary practice location

100 E Lefevre Rd
Sterling, IL 61081-1278

Mailing address

100 E Lefevre Rd
Sterling, IL 61081-1278
Phone (815) 625-0400

Other identifiers 2

IdentifierTypeStateIssuer
036117094MedicaidIL
P00405463OtherRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address phong.dang.p1@direct.cghmc.nextgenshare.com

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
I20070714000186 IL Practitioner - Family Practice 7719087121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CGH Medical CenterGroup PAC ID 6103723267, 199 clinicians

Practice addresses (Care Compare)

101 E Miller Rd
Sterling, IL 61081-1252
Phone (815) 625-4790

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
34.58 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
40
Cost
40.76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.117094ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CGH Medical Center Current Accepting new patients

Locations

711 S Division Ave
Polo, IL 61064
Phone (815) 946-3661

100 E Lefevre Rd
Sterling, IL 61081
Phone (815) 625-0400

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

15 W 3rd St
Sterling, IL 61081
Phone (815) 564-1999

Interoperability endpoints

  • Direct secure messaging: pdang20915@cghmc.direct-ci.com

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1447394465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LEFEVRE RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811278",
            "telephone_number": "815-625-0400",
            "fax_number": "815-625-6728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEFEVRE RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811278",
            "telephone_number": "815-625-0400",
            "fax_number": "815-625-6728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANG",
        "first_name": "PHONG",
        "middle_name": "DAO LAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.117094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036117094",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00405463",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "phong.dang.p1@direct.cghmc.nextgenshare.com",
            "affiliation": "N",
            "address_1": "100 E Lefevre Rd",
            "city": "Sterling",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610811278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sterling, IL

Sources for this page

Verify at the official NPI Registry.