Definitive Neurodiagnostics, LLC Professional Services

Primary specialty

Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X

License

036100906 Issued in IL

Legal business name

DEFINITIVE NEURODIAGNOSTICS, LLC PROFESSIONAL SERVICES

Practice address

1604 Visa Dr # 1
Normal, IL 61761-2195

Phone

(309) 454-1100

NPI assigned

Jan 30, 2015

Organization subpart

Yes

Parent organization

DEFINITIVE NEURODIAGNOSTICS, LLCAs reported in NPPES

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

Authorized official

Name

Dr. John G Atwater, M.D.

Title

Owner

Phone

(309) 454-1100

Specialties & licenses 1

Addresses

Part of

Definitive Neurodiagnostics LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Definitive Neurodiagnostics LLC

  • Electroneurodiagnostic Specialist/Technologist
  • Normal, IL
  • NPI 1659490761
  NPPES parent name

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1629468541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 VISA DR # 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 VISA DR # 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-454-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFINITIVE NEURODIAGNOSTICS, LLC PROFESSIONAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEFINITIVE NEURODIAGNOSTICS, LLC",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "ATWATER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-454-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": "IL",
            "license": "036100906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adeyosoye Dawodu, M.D.
• Dba Developing Melodies
• Leah Dean, CRNA
• Laura Deffley
• Definitive Neurodiagnostics LLC
• Definitive Neurodiagnostics, LLC Technical Services
• Jason Joseph Degenhart, PHARM. D. RPH
• Marco Ramon Del Castillo, M.D.
• Alberto L. Delgado, M.D.
• Jamy Delk, MSW

• Electroneurodiagnostic Specialist/Technologist in Normal, IL
• Providers in Normal, IL by specialty
• Electroneurodiagnostic Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.