Herman Justis Dick Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036056374 Issued in IL

Practice address

2204 Eastland Dr
Bloomington, IL 61704-3566

Phone

(309) 662-9461

Fax

(309) 663-0222

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment NPD
• Carle West Physician Group Inc

  • Family Medicine Physician
  • Normal, IL
  • NPI 1467074138
  Medicare reassignment NPD
• McLean County Neurology SC

  • Neurology Physician
  • Bloomington, IL
  • NPI 1760431712
  NPD (past) Authorized official
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD
• Bromenn Healthcare, Inc.

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1184808404
  NPD (past)
• Illinois Cardiac Surgery Associates SC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Peoria, IL
  • NPI 1114018439
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1891891370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 EASTLAND DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043566",
            "telephone_number": "309-662-9461",
            "fax_number": "309-663-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 EASTLAND DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043566",
            "telephone_number": "309-662-9461",
            "fax_number": "309-663-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICK",
        "first_name": "HERMAN",
        "middle_name": "JUSTIS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036056374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5715381",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "130005238",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056374",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rubina Dhillon
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• Melinda Sue Dial, FNP
• Dialysis Centers of America - Illinois, Inc.
• Dialysis Centers of America - Illinois, Inc.
• Chad Dickey
• Mazzy J Dicriscio
• Debra Dietrich, PSYCHOLOGIST
• Sara E Dietz
• Samantha Dilley, MS

• Specialist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.