Angelito Dariel Tacderas, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209.007762 Issued in IL

Practice address

3331 W Deyoung St
Ste 308
Marion, IL 62959-5896

Phone

(618) 997-1200

Fax

(618) 997-1212

NPI assigned

Sep 15, 2009

Last updated

Sep 15, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kemell Health LLCGroup PAC ID 5597189571, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Deaconess Illinois Union County Hospital, Anna, IL, CCN 141342

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: angelito.tacderas.1@29249.direct.athenahealth.com

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.

• Kemell Health LLC

  • Family Medicine Physician
  • New Glarus, WI
  • NPI 1487274247

  IL

  Medicare reassignment Care Compare group NPD
• Advanced Kidney Institute, L.L.C.

  • Nephrology Physician
  • Marion, IL
  • NPI 1932237815
  Medicare reassignment NPD
• Allan C Gocio MD Neurosurgical Care, LLC

  • Neurological Surgery Physician
  • Marion, IL
  • NPI 1205074093
  NPD (past)
• Angel Care Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Marion, IL
  • NPI 1750837043
  NPD (past)

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

• Deaconess Illinois Union County Hospital Inc

  dba Deaconess Illinois Union County

  • Critical Access Hospital
  • Anna, IL
  • NPI 1710604483
  Care Compare affiliation

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1467785014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629590430",
            "telephone_number": "618-997-1200",
            "fax_number": "618-997-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST",
            "address_2": "STE 308",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-997-1200",
            "fax_number": "618-997-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACDERAS",
        "first_name": "ANGELITO",
        "middle_name": "DARIEL",
        "name_prefix": "Mr.",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.007762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffiny Sweet, RN
• Dustin Swick
• Katelyn Swick
• Mitchell S Swieca, PA
• Kathryn Swinford, PTA
• Valerie L Tallman, M.S.
• Weiyi Tang, MD
• Sarah Ali Tariq, DO
• Sandra Tate, APN, PMNCNS-BC
• Brian Thomas Taylor, P.T.

• Nurse Practitioner in Marion, IL
• Providers in Marion, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.