Individual provider Active NPI

Bryan A. McDonald, MD

  • Family Medicine Physician
  • Rockford, IL
National Provider Identifier
1669582854
Registry record updated Jan 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-051276 Issued in IL
Practice address
2300 N Rockton Ave
Rockford, IL 61103-3619
Phone
(815) 971-2000
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2010

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 036-051276 IL Primary

Addresses

Primary practice location

2300 N Rockton Ave
Rockford, IL 61103-3619

Mailing address

2300 N Rockton Ave
Rockford, IL 61103-3619
Phone (815) 971-2000

Other identifiers 1

IdentifierTypeStateIssuer
036051276MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050108000129 IL Practitioner - Family Practice 7719935527 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-051276ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Jul 1, 1987 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Nov 16, 2017 Accepting new patients
Rockford Health Physicians CurrentSince Jul 1, 1987 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Nov 16, 2017 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

Use C15362
Carol Stream, IL 60122

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

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

5970 Churchview Dr
Rockford, IL 61107
Phone (815) 971-8990

1221 E State St
Rockford, IL 61104
Phone (815) 972-1000

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

2623 Edgemont St
Rockford, IL 61101

Interoperability endpoints

  • Direct secure messaging: bmcdonald17625@uihealth.direct-ci.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263772800000",
    "number": "1669582854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033619",
            "telephone_number": "815-971-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033619",
            "telephone_number": "815-971-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "BRYAN",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-051276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036051276",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.