NPIMap

Individual provider Active NPI

Glen E Dust, M.D.

  • Family Medicine Physician
  • Monticello, IL
National Provider Identifier
1477555738
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036068658 Issued in IL
Practice address
1000 Medical Center Dr
Monticello, IL 61856-2116
Phone
(217) 762-6241
Fax
(217) 762-1702
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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 036068658 IL Primary

Addresses

Primary practice location

1000 Medical Center Dr
Monticello, IL 61856-2116

Mailing address

1000 Medical Center Dr
Monticello, IL 61856-2116
Phone (217) 762-6241

Other identifiers 4

IdentifierTypeStateIssuer
0360686581MedicaidIL
080027217OtherILPALMETTO
0007000023OtherILBCBS OF ILLINOIS
182358OtherILHEALTHLINK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gdust@kmc.kirbymedicalcenter.net Direct

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
I20100901000604 IL Practitioner - Family Practice 5395716575 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), 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kirby Medical CenterGroup PAC ID 6901791144, 80 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Dr
Monticello, IL 61856-2116
Phone (217) 762-1540

Hospital & facility affiliations

  • Community Homecare, Inc Home health agency, Sullivan, IL, CCN 147774
  • Kirby Medical Center Hospital, Monticello, IL, CCN 141301
  • St Marys Hospital Hospital, Decatur, IL, CCN 140166
  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kirby Medical Center CurrentSince Aug 7, 2023 Accepting new patients
Kirby Medical Center Family Medicine CurrentSince Aug 7, 2023 Accepting new patients
Kirby Medical Center Past Accepting new patients

Locations

1000 Medical Center Dr
Monticello, IL 61856
Phone (217) 762-1540

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1477555738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER DR",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618562116",
            "telephone_number": "217-762-6241",
            "fax_number": "217-762-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER DR",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618562116",
            "telephone_number": "217-762-6241",
            "fax_number": "217-762-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUST",
        "first_name": "GLEN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036068658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360686581",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "080027217",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "0007000023",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "182358",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gdust@kmc.kirbymedicalcenter.net",
            "affiliation": "N",
            "endpointDescription": "Kirby Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1000 Medical Center Dr",
            "city": "Monticello",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618562116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monticello, IL

Sources for this page

Verify at the official NPI Registry.