Individual provider Active NPI

Ann Marie Dilla, DO

  • Family Medicine Physician
  • McHenry, IL
National Provider Identifier
1568490977
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-085669 Issued in IL
Practice address
2507 N Richmond Rd
McHenry, IL 60051
Phone
(815) 338-6600
Fax
(815) 759-4078
NPI assigned
Jun 28, 2006
Last updated
Oct 19, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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 036-085669 IL Primary

Addresses

Primary practice location

2507 N Richmond Rd
McHenry, IL 60051

Mailing address

2507 N Richmond Rd
McHenry, IL 60051-5407
Phone (815) 338-6600

Other identifiers 1

IdentifierTypeStateIssuer
036085669OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200227002726 WI Practitioner - Family Practice 0840391850 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-085669ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Feb 17, 2020 Accepting new patients
Mercy Health System Corporation CurrentSince Feb 17, 2020 Accepting new patients
Bonaventure Medical Foundation, LLC Family Medicine Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3524 E Milwaukee St
Janesville, WI 53546
Phone (608) 756-7100

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1568490977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 N RICHMOND RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600515407",
            "telephone_number": "815-338-6600",
            "fax_number": "815-759-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 N RICHMOND RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60051",
            "telephone_number": "815-338-6600",
            "fax_number": "815-759-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLA",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-085669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036085669",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.