Active NPI
Dean Fondahn, M.D.
- Urology Physician
- Sterling, IL
National Provider Identifier
1710074653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 036066790
- Practice address
- 101 E Miller Rd
Sterling, IL 61081-1252 - Phone
- (815) 625-4790
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 036066790 | IL | Primary |
Addresses
Primary practice location
101 E Miller Rd
Sterling, IL 61081-1252
Mailing address
PO Box 5009
Brentwood, TN 37024-5009
Phone (615) 221-3642
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012794 | Other | IL | HEALTH ALLIANCE MEDICAL |
| 036066790 | Medicaid | IL | |
| 9815737 | Other | IL | BLUE CROSS BLUE SHIELD |
| 340007312 | Other | RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sterling Rock Falls Clinic | Past | Accepting new patients | |
| CGH Medical Center | Past | Accepting new patients | |
| Sterling Rock Falls Clinic, LTD | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Sterling, IL
- NPI 1902854623
-
- Multi-Specialty Clinic/Center
- Dixon, IL
- NPI 1588746101
-
- Multi-Specialty Clinic/Center
- Morrison, IL
- NPI 1760564330
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543795200000",
"number": "1710074653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5009",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370245009",
"telephone_number": "615-221-3642",
"fax_number": "615-371-4600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E MILLER RD",
"city": "STERLING",
"state": "IL",
"postal_code": "610811252",
"telephone_number": "815-625-4790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONDAHN",
"first_name": "DEAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2018-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "036066790",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE MEDICAL",
"identifier": "012794",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036066790",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "9815737",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "340007312",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Sterling, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.