Individual provider Active NPI

David T Thom, DPM

  • Podiatrist
  • Rockford, IL
National Provider Identifier
1902484405
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016006060 Issued in IL
Practice address
5875 E Riverside Blvd
Rockford, IL 61114-4937
Phone
(815) 398-9491
Fax
(815) 381-7498
NPI assigned
Mar 29, 2021
Last updated
Aug 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016006060 IL Primary

Addresses

Primary practice location

5875 E Riverside Blvd
Rockford, IL 61114-4937

Mailing address

5875 E Riverside Blvd
Rockford, IL 61114-4937
Phone (815) 398-9491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240624004388 IL Practitioner - Podiatry 1153864749 Reassigns benefits to 1 organization
I20241028002807 WI Practitioner - Podiatry 1153864749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

324 Roxbury Rd
Rockford, IL 61107-5090
Phone (815) 398-9491

5875 E Riverside Blvd
Rockford, IL 61114-4937

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orthomidwest, PLLC CurrentSince May 9, 2024 Accepting new patients
Orthomidwest, PLLC CurrentSince May 9, 2024 Accepting new patients
Orthomidwest, PLLC Podiatrist CurrentSince Aug 5, 2024 Accepting new patients

Locations

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

324 Roxbury Rd
Rockford, IL 61107
Phone (815) 381-7339

535 Roxbury Rd
Rockford, IL 61107
Phone (815) 387-1717

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

5875 E Riverside Blvd
Rockford, IL 61114
Phone (779) 774-1270

8400 Lakeview Pkwy
Ste 800
Pleasant Prairie, WI 53158
Phone (262) 455-7548

Interoperability endpoints

  • Direct secure messaging: david.thom@ro.eclinicaldirectplus.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1902484405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5875 E RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144937",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5875 E RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144937",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOM",
        "first_name": "DAVID",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016006060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.