Individual provider Active NPI

Timothy Michael Dolan, CRNA

  • Certified Registered Nurse Anesthetist
  • Loves Park, IL
National Provider Identifier
1932653516
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209014799 Issued in IL
Practice address
2202 Harlem Rd
Suite 200
Loves Park, IL 61111-2754
Phone
(815) 877-4848
NPI assigned
Aug 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041327743 IL
Registered Nurse 163W00000X 197396-30 WI
Certified Registered Nurse Anesthetist 367500000X 209014799 IL Primary

Addresses

Primary practice location

2202 Harlem Rd
Suite 200
Loves Park, IL 61111-2754

Mailing address

8575 Yellowstone Dr
Byron, IL 61010-9769
Phone (815) 234-4185

Other practice location 1

1 Medical Center Dr
Galena, IL 61036-8118
Phone (815) 777-1340

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address midwestmedical@midwestmedicalcenter.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160923001351 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6507153228 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1016 Featherstone Rd
Rockford, IL 61107-5902
Phone (815) 226-3300

1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000

403 E 1St St
Dixon, IL 61021-3116
Phone (815) 288-5531

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
041327743ILMDRegistered Nurse
197396-30WIMDRegistered Nurse
209014799ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Anesthesiologists Associated, L.L.C. CurrentSince Sep 14, 2016 Accepting new patients
Midwest Medical Center CurrentSince Mar 24, 2024 Accepting new patients
Midwest Medical Center CurrentSince Mar 24, 2024 Accepting new patients
Rockford Anesthesiologists Associated, L.L.C. Nurse Anesthetist, Certified Registered CurrentSince Sep 14, 2016 Accepting new patients

Locations

1 Medical Center Dr
Galena, IL 61036
Phone (815) 776-7381

2202 Harlem Rd
#200
Loves Park, IL 61111
Phone (815) 877-4848

1016 Featherstone Rd
Rockford, IL 61107
Phone (815) 226-3300

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

Interoperability endpoints

  • Direct secure messaging: midwestmedical@midwestmedicalcenter.cernerdirect.com

Organizations & group practices 4

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 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": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1932653516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8575 YELLOWSTONE DR",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610109769",
            "telephone_number": "815-234-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 HARLEM RD",
            "address_2": "SUITE 200",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Galena",
            "state": "IL",
            "postal_code": "610368118",
            "country_code": "US",
            "telephone_number": "815-777-1340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLAN",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-11",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041327743",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "197396-30",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209014799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "midwestmedical@midwestmedicalcenter.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Midwest Medical Center Direct Email Access",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1 Medical Center Dr",
            "city": "Galena",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610368118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Loves Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.