Dale D Zimmerman, D.O.
Individual provider
Active NPI
Family Medicine Physician · Warsaw, IL
NPI 1720169899 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1720169899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036150944 (IL)
- Practice address
- 1102 N County Road 700
Warsaw, IL 62379-3011
- Phone
- (217) 256-4100
- Fax
- (217) 256-3800
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20071130000515 |
MO |
Practitioner - Family Practice |
3375632144 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|
| DO101841 | MO | MD | Family Medicine Physician |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Family Medicine Physician |
207Q00000X |
DO101841 |
MO |
|
| Family Medicine Physician |
207Q00000X |
036150944 |
IL |
Yes |
Addresses
Primary practice location
1102 N County Road 700
Warsaw, IL 62379-3011
Mailing address
1102 N County Road 700
Warsaw, IL 62379-3011
Phone (217) 256-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 243451218 | Medicaid | MO | |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|
| CONNECT URL |
https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service |
Other |
|