Mary T. Dambacher, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209010559 Issued in IL

Practice address

2200 Shale St
Springfield, IL 62703-5625

Phone

(217) 788-2321

Fax

(217) 679-7291

NPI assigned

Jul 29, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2013

Medicare assignment

May accept Medicare assignment

Group practices

Central Counties Health Centers, Inc.Group PAC ID 3274445762, 16 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

79.44 of 100Reported as group

Quality

71.79

Promoting interoperability

77

Improvement activities

40

Cost

75.71

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

Practice roles

Locations

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.

• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1861480709
  Medicare reassignment Care Compare group NPD
• Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1861911893
  NPD

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1477995611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2239 E COOK ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031944",
            "telephone_number": "217-788-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 SHALE ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627035625",
            "telephone_number": "217-788-2321",
            "fax_number": "217-679-7291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2239 E Cook St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627031944",
            "country_code": "US",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAMBACHER",
        "first_name": "MARY",
        "middle_name": "T.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-29",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Dale
• Stephanie Margaret Dalla Riva, MD
• Pamela Sue Dalsin, RN
• Rucha Haily Dalvi, M.D.
• Anne Elizabeth Daly, MS, RD, BC-ADM, CDE
• Haylie A Damhoff, DNP, FNP-BC
• Tiffany Lynn Damm, MD
• Linh Chau Khanh Dang, MD
• Jackie Lynn Daniels-Lausen, D.C.
• Carla J. Daniels, N.P.

• Family Nurse Practitioner in Springfield, IL
• Providers in Springfield, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.