Active NPI
Daniel Thomas Davison, D.O.
- Sports Medicine (Family Medicine) Physician
- Chicago, IL
National Provider Identifier
1750431870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 036059839
- Practice address
- 6500 W 65TH St
Chicago, IL 60638-4962 - Phone
- (708) 496-1515
- Fax
- (708) 495-1788
- NPI assigned
- Jan 11, 2007
- Last updated
- Jan 26, 2017
- 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 |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 036059839 | IL | Primary |
Addresses
Primary practice location
6500 W 65TH St
Chicago, IL 60638-4962
Mailing address
6500 W 65TH St
Chicago, IL 60638-4962
Phone (708) 496-1515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036059839 | Medicaid | IL |
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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients | |
| Macneal Physicians Group LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Gibson Area Hospital and Health Services
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
-
dba Vanguard Medical Group
- Internal Medicine Physician
- Berwyn, IL
- NPI 1205024791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1750431870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 W 65TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606384962",
"telephone_number": "708-496-1515",
"fax_number": "708-496-1788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 W 65TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606384962",
"telephone_number": "708-496-1515",
"fax_number": "708-495-1788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "DANIEL",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "IL",
"license": "036059839",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036059839",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.