NPIMap

Individual provider Active NPI

Dean Ryan Davis, MD

  • Family Medicine Physician
  • Forsyth, IL
National Provider Identifier
1700847191
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036150782 Issued in IL
Practice address
241 W Weaver Rd Ste 145a
Forsyth, IL 62535-9765
Phone
(217) 876-5270
Fax
(217) 875-4001
NPI assigned
Mar 28, 2006
Last updated
Dec 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125071567 IL
Family Medicine Physician 207Q00000X 036150782 IL Primary

Addresses

Primary practice location

241 W Weaver Rd Ste 145a
Forsyth, IL 62535-9765

Mailing address

4155 McClain Dr
Decatur, IL 62526-1238
Phone (217) 875-0227

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200219001146 IL Practitioner - Family Practice 9830171321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Decatur Memorial HospitalGroup PAC ID 6204731144, 173 clinicians

Practice addresses (Care Compare)

241 W Weaver Rd
Suite 145a
Forsyth, IL 62535-9765
Phone (217) 876-5270

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125071567ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Decatur Memorial Hospital Family Medicine CurrentSince Jan 10, 2020 Accepting new patients
Springfield Clinic LLP Current Accepting new patients
Memorial Health Partners Family Medicine Current Accepting new patients
Decatur Memorial Hospital CurrentSince Jan 10, 2020 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Illiana Emergency Physicians, LLP Past Accepting new patients
Illiana Emergency Physicians LLP Past Accepting new patients

Locations

102 W Kenwood Ave
Ste 110
Decatur, IL 62526
Phone (217) 876-5870

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

241 W Weaver Rd
Ste 145A
Forsyth, IL 62535
Phone (217) 876-5270

241 W Weaver Rd
Ste 145B
Forsyth, IL 62535
Phone (217) 876-5220

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

Interoperability endpoints

  • Direct secure messaging: deandavis@memorial.allscriptsdirect.net
  • Direct secure messaging: deandavis@sfc.allscriptsdirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1700847191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4155 MCCLAIN DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625261238",
            "telephone_number": "217-875-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 W WEAVER RD STE 145A",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359765",
            "telephone_number": "217-876-5270",
            "fax_number": "217-875-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DEAN",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125071567",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036150782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forsyth, IL

Sources for this page

Verify at the official NPI Registry.