DR. JONATHAN RODERICK DUTT (NPI# 1497277263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497277263 |
| Entity Type | Individual |
| Full Name | DR. JONATHAN RODERICK DUTT |
| Credential | MD |
| Practice Address |
102 W Kenwood Ave Decatur IL 62526-4368 |
| Mailing Address |
Po Box 19639 Springfield IL 62794-9639 |
| Practice Telephone | 2175458000 |
| Mailing Telephone | 2175457578 |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2020-05-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 125.071354 | IL | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | 036-151311 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
102 W KENWOOD AVE |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4368 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376534636 | Jeffrey Bruce Rounds | Specialist/Technologist | 102 W Kenwood Ave, Decatur, IL 62526-4300 | 2005-11-04 |
| 1407376338 | Board of Trustees of Southern Illinois University | Clinic/Center | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2017-06-21 |
| 1992234504 | Nicole Gabriel Tenegra | Family Medicine | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2017-06-07 |
| 1811340979 | Aimen Naeem | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-07-13 |
| 1528411683 | Hema Patel | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-07-13 |
| 1578914867 | Deepti Sood | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-06-28 |
| 1780065730 | Zeerak Qureshi | Family Medicine | 102 W Kenwood Ave, Ste 100, Decatur, IL 62526-4368 | 2015-06-16 |
| 1780076901 | Audra L Trump | Nurse Practitioner | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2015-02-25 |
| 1619396736 | Michael Knobeloch | Counselor | 102 W Kenwood Ave, Suite 120a, Decatur, IL 62526-4368 | 2014-04-16 |
| 1932464633 | Alicia Koontz | Physical Therapy Assistant | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2012-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205481736 | Northside Nama Professional Services, LLC | Internal Medicine | 2545 Lawrenceville Hwy Ste 200, Decatur, GA 30033-3240 | 2019-08-01 |
| 1235632282 | Integrated Health and Wellness, LLC | Internal Medicine | 4150 Snapfinger Woods Dr Ste 200, Decatur, GA 30035-3417 | 2018-03-16 |
| 1619487428 | William Charles Levine | Internal Medicine | 2488 Pangborn Cir, Decatur, GA 30033-1341 | 2017-10-06 |
| 1730603267 | Snapcare Clinic | Internal Medicine | 5071 Snapfinger Woods Dr, Decatur, GA 30035-4019 | 2017-07-26 |
| 1629520515 | Daniel Feikin | Internal Medicine | 1726 Oakview Rd, Decatur, GA 30030-4235 | 2016-10-26 |
| 1699168237 | Valley Internal Medicine and Pediatrics | Internal Medicine | 2506 Danville Rd Sw # B, Decatur, AL 35603-4232 | 2015-03-06 |
| 1740691120 | Sandra J. Valenciano | Internal Medicine | 445 Winn Way Ste 527, Decatur, GA 30030-1707 | 2014-05-19 |
| 1376964593 | Naomi Bock | Internal Medicine | 335 W Ponce De Leon Ave Unit 501, Decatur, GA 30030-2456 | 2013-12-16 |
| 1548693641 | Timothy P. Weirich, M.d., P.C. | Internal Medicine | 3505 Pinehurst Dr Sw, Decatur, AL 35603-1259 | 2013-08-13 |
| 1154760577 | Michael William Smith | Internal Medicine | 2434 Vivian Cir, Decatur, GA 30030-1592 | 2013-06-19 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.