DANE JACK CHURCH (NPI# 1790128387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790128387 |
| Entity Type | Individual |
| Full Name | DANE JACK CHURCH |
| Credential | MD |
| Practice Address |
1301 S Koke Mill Rd Springfield IL 62711-9252 |
| Practice Telephone | 2175479100 |
| Practice Fax Number | 2175479236 |
| Mailing Telephone | 2175479100 |
| Mailing Fax Number | 2175479236 |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-04-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
036148467 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2301 Holmes St, Kansas City, MO 641082640 | 8164044175 |
| Street Address |
1301 S KOKE MILL RD |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62711-9252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902892607 | D Gordon Allan | Orthopaedic Surgery | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2005-09-27 |
| 1558973461 | Charity E Williams | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-08-21 |
| 1811509821 | Christina Prefountain | Registered Nurse | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-08-20 |
| 1467061408 | Daniel S Rebeck | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-07-27 |
| 1245850767 | Zachary M Barnett | Physician Assistant | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-24 |
| 1356961908 | Jessica Brough | Physician Assistant | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-23 |
| 1013536093 | Molly L Morgan | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-10 |
| 1326670183 | Jeffery R Chambers | Nurse Practitioner | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-02-10 |
| 1225677396 | Carrie F Thornton | Registered Nurse | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-01-06 |
| 1730724972 | Lindsay Breanne Dixon | Nurse Practitioner | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2019-11-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578057220 | Merissa Pryor | Social Worker | 4200 Conestoga Drive, Mbn 120, Springfield, IL 62711 | 2018-06-17 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1841682424 | Americare At Centennial Pointe Assisted Living LLC | Assisted Living Facility | 3440 Hedley Road, Springfield, IL 62711 | 2015-02-19 |
| 1306249248 | Schon Dental, LLC | Dentist | 2809 Mansion Road Suite D, Springfield, IL 62711 | 2014-10-07 |
| 1891105490 | John Weiss | Pharmacist | 4200 Conestoga Drive, Springfield, IL 62711 | 2014-05-05 |
| 1720350689 | Victor Harold Lary | Family Medicine | 3251 Spaulding Orchard Road, Springfield, IL 62711 | 2012-02-07 |
| 1902181795 | Amanda Rose Davis | Pharmacist | 2500 Koke Mill Rd, Springfield, IL 62711 | 2011-10-12 |
| 1316233703 | Karen Zerkle | Dentist | 2809 Mansion Rd, Suite D, Springfield, IL 62711 | 2011-06-23 |
| 1255520557 | Link Chiropractic LLC | Chiropractor | 7012 Kingsmill Ct, Springfield, IL 62711 | 2007-10-23 |
| 1669688230 | Victoria Lynn Driskill | Dentist | 4701 W. Wabash Ave, Springfield, IL 62711 | 2007-05-14 |
| Find all providers in zip 62711 | ||||
| Taxonomy Code | 207XS0114X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Adult Reconstructive Orthopaedic Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154321222 | Piero Capecci | Orthopaedic Surgery | 800 N 1st St, Springfield, IL 62702-3719 | 2005-07-29 |
| 1265701304 | Tattnall Hospital Company LLC | Orthopaedic Surgery | 459 Ga Highway 119 S, Springfield, GA 31329-3021 | 2011-12-19 |
| 1275677023 | Putnam Orthopaedic Center, LLC | Orthopaedic Surgery | 4350 S National Ave, Suite C200, Springfield, MO 65810-2607 | 2007-02-16 |
| 1669457917 | William T Wester | Orthopaedic Surgery | 3555 S National Ave, Springfield, MO 65807-7310 | 2005-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578901799 | Kevin Christopher Bigart | Orthopaedic Surgery | 688 Cedar Crossings Dr, New Lenox, IL 60451-5200 | 2013-06-10 |
| 1174899207 | Sara Wallace | Orthopaedic Surgery | 5814 S Maryland Ave # Mc3079, Chicago, IL 60637 | 2012-03-22 |
| 1699909887 | Anand Srinivasan | Orthopaedic Surgery | 2850 Ridge Ave, Ste 880, Evanston, IL 60201 | 2009-05-04 |
| 1114184058 | Denis Nam | Orthopaedic Surgery | 1611 W Harrison St Ste 300, Chicago, IL 60612 | 2008-05-19 |
| 1376610634 | Gregg Michael Moga | Orthopaedic Surgery | 6025 Pebble Creek Ct, Gurnee, IL 60031-4722 | 2006-11-29 |
| 1134233299 | Raymond Donald Santucci | Orthopaedic Surgery | 5n467 Curling Pond Rd # 533, Wayne, IL 60184-2226 | 2006-08-18 |
| 1407835135 | Wayne Paprosky | Orthopaedic Surgery | 25 North Winfield Rd, Winfield, IL 60190 | 2006-01-11 |
| 1528445152 | Korey Douglas Partenheimer | Orthopaedic Surgery | 5841 S Maryland Ave, M/c 3079, Chicago, IL 60637-1443 | 2015-05-04 |
| 1922495068 | Darren Plummer | Orthopaedic Surgery | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2015-04-15 |
| 1457745416 | Mark Zekaj | Orthopaedic Surgery | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2015-03-26 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 62711 |
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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.