Michal Dynda, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-124741 Issued in IL

Practice address

520 N 4TH St
Springfield, IL 62702-5238

Phone

(217) 757-8100

Fax

(217) 747-1351

NPI assigned

Jan 14, 2008

Last updated

Apr 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, 139 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Springfield, IL, CCN 140148

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michaldynda@siusm.allscriptsdirect.net

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Board of Trustees of Southern Illinois University

  dba Siu Quincy Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Quincy, IL
  • NPI 1376921924

  W-2 Managing Employee

  CMS ownership
• Board of Trustees of Southern Illinois University

  dba Siu Center for Family Medicine-Jacksonville

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, IL
  • NPI 1649628009

  W-2 Managing Employee

  CMS ownership
• Board of Trustees of Southern Illinois University

  dba SIU Center for Family Medicine - Lincoln

  • Federally Qualified Health Center (FQHC)
  • Lincoln, IL
  • NPI 1972049641

  Corporate Officer

  CMS ownership

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.

• Board of Trustees of Southern Illinois University

  dba Siu Center for Family Medicine

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Board of Trustees of Southern Illinois University

  dba Carbondale Care A Van

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD
• Board of Trustees of Southern Illinois University

  dba SIU Center for Family Medicine - Care-A-Van

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1568210425
  NPD
• Board of Trustees of Southern Illinois University

  dba Noll Medical Pavilion Clinic

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1922350099
  NPD
• Memorial Expresscare, LLC

  • Family Medicine Physician
  • Springfield, IL
  • NPI 1750532362
  NPD (past)
• Midwest Emergency Department Specialists LTD

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1245263367
  NPD (past)
• Southern Illinois University

  dba Community Nursing Services

  • Clinic/Center
  • E Saint Louis, IL
  • NPI 1306273776
  NPD (past)

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

• Memorial Medical Center

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1255317590
  Care Compare affiliation

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1578749164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MADISON ST STE 328",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025131",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 4TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025238",
            "telephone_number": "217-757-8100",
            "fax_number": "217-747-1351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 3rd St",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "IL",
            "postal_code": "626562604",
            "country_code": "US",
            "telephone_number": "217-735-2317",
            "fax_number": "217-732-6943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 E State St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "IL",
            "postal_code": "626502125",
            "country_code": "US",
            "telephone_number": "217-408-1195",
            "fax_number": "217-408-1231",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2833 S Grand Ave E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627032175",
            "country_code": "US",
            "telephone_number": "217-789-2069",
            "fax_number": "217-535-3104",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3220 Atlanta St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627078801",
            "country_code": "US",
            "telephone_number": "217-545-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 N 8th St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627026324",
            "country_code": "US",
            "telephone_number": "217-588-7717",
            "fax_number": "217-525-1503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 E Bidwell St",
            "address_purpose": "LOCATION",
            "city": "Taylorville",
            "state": "IL",
            "postal_code": "625681363",
            "country_code": "US",
            "telephone_number": "217-824-1134",
            "fax_number": "217-824-4404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYNDA",
        "first_name": "MICHAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-14",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-124741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036124741",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raeanne Dutz, LPC
• Gilbert Shawn Duxbury, M.D.
• Dva Renal Healthcare Inc (Springfield Montvale Dialysis)
• Dva Renal Healthcare Inc (Springfield Central Dialysis)
• Ashley N Dyas, NP
• Sandra K Eades, LCPC
• Lanie E Eagleton, M.D.
• Linda J Eagleton
• Kelsi Earl, APN
• Kim A Earl, APRN, PMHNP, FNP

• Family Medicine Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.