Diana T Widicus, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36062017 Issued in IL

Practice address

300 Sattley St
Rochester, IL 62563-9241

Phone

(217) 789-3630

Fax

(217) 498-6812

NPI assigned

Oct 16, 2006

Last updated

Dec 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: dwidicus33278@ewd.direct.hshs.org

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1851471072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH MACARTHUR BLVD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62704",
            "telephone_number": "217-789-1403",
            "fax_number": "217-789-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SATTLEY ST",
            "city": "ROCHESTER",
            "state": "IL",
            "postal_code": "625639241",
            "telephone_number": "217-789-3630",
            "fax_number": "217-498-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDICUS",
        "first_name": "DIANA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36062017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwidicus33278@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "300 Sattley St",
            "city": "Rochester",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625639241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael David Speck, PHARMD
• Cheryl Sue Swenny, LCPC
• Matthew Jules Swenny, MS LCPC
• The Rooted Wellness Group PLLC
• Catherine Mary Chrietzberg Wells, L.C.P.C.
• Douglas Allen Zobrist, D.C, M.P.H.

• Family Medicine Physician in Rochester, IL
• Providers in Rochester, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.