Mida N Bautista-Dittmar, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

70007736 Issued in IL

Practice address

1627 4TH St
Peru, IL 61354-3507

Phone

(815) 223-4479

Fax

(815) 223-4489

NPI assigned

Aug 30, 2006

Last updated

Jan 14, 2009By 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

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

City Center Rehabilitation West - Inc.Group PAC ID 6901963164, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• City Center Rehabilitation West - Inc.

  • Physical Therapy Clinic/Center
  • Peru, IL
  • NPI 1396981742
  Medicare reassignment Care Compare group NPD
• City Center Physical Therapy - Peru, Inc.

  • Physical Therapist
  • Peru, IL
  • NPI 1043362965
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231891200000",
    "number": "1982714010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 764",
            "city": "CHANNAHON",
            "state": "IL",
            "postal_code": "604100764",
            "telephone_number": "815-223-4479",
            "fax_number": "815-223-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 4TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543507",
            "telephone_number": "815-223-4479",
            "fax_number": "815-223-4489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA-DITTMAR",
        "first_name": "MIDA",
        "middle_name": "N",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "70007736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haleigh Catherine Augspols, MS, RD, LDN
• Austriaco Dental Associates - Peru LLC
• Juli Baker
• Emily Balestri, DPT
• Jane Battles, APN
• Tamara Leigh Beaber, LSW
• Kami Lynn Becker
• Angela Benavides, MD
• Alejandro B Bernal, MD
• Sondra L Blocki, MSPT

• Physical Therapist in Peru, IL
• Providers in Peru, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; 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.