Individual provider Active NPI

Dana Dalbak, PA-C

  • Physician Assistant
  • Normal, IL
National Provider Identifier
1790721298
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085002948 Issued in IL
Practice address
2010 Jacobssen Dr
Normal, IL 61761-6280
Phone
(309) 452-0995
Fax
(309) 862-0961
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085002948 IL Primary

Addresses

Primary practice location

2010 Jacobssen Dr
Normal, IL 61761-6280

Mailing address

2010 Jacobssen Dr
Normal, IL 61761-6280
Phone (309) 452-0995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130128000116 IL Practitioner - Physician Assistant 4385898451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Allergy Sinus Asthma SCGroup PAC ID 3870722283, 9 clinicians

Practice addresses (Care Compare)

2010 Jacobssen Dr
Normal, IL 61761-6280
Phone (309) 452-0995

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085002948ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association 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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1790721298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 JACOBSSEN DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616280",
            "telephone_number": "309-452-0995",
            "fax_number": "309-862-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 JACOBSSEN DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616280",
            "telephone_number": "309-452-0995",
            "fax_number": "309-862-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALBAK",
        "first_name": "DANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.