Northern Illinois Podiatry PC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

NORTHERN ILLINOIS PODIATRY PC

Practice address

521 W Main St
Freeport, IL 61032

Phone

(815) 233-0211

Fax

(815) 233-0214

NPI assigned

May 11, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Keith Dickey, DPMNPI 1730103094

Title

Owner

Phone

(815) 233-0211

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol Ann Wisniewski, DPM

  • Podiatrist
  • Freeport, IL
  • NPI 1316961675
  Medicare reassignment NPD
• Ronald Keith Dickey, DPM

  • Podiatrist
  • Freeport, IL
  • NPI 1730103094
  NPD Authorized official

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740495944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W MAIN ST",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-233-0211",
            "fax_number": "815-233-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W MAIN ST",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-233-0211",
            "fax_number": "815-233-0214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICKEY",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-233-0211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Freeport, IL
• Providers in Freeport, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.