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MARY T. DAMBACHER FNP-BC
NPI 1477995611
Nurse Practitioner - Family in Springfield, IL

Active since July 29, 2013PECOS Enrolled
72.14/100
CMS Quality Rating
2200 SHALE ST, SPRINGFIELD, IL 62703(217) 788-2321(217) 679-7291 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jun 13, 2025, Mar 20, 2025 (2 updates tracked since 2025).

About Mary T. Dambacher Fnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY T. DAMBACHER FNP-BC (NPI 1477995611) is an individual family provider in Springfield, Illinois, licensed in Illinois (209010559) and active in the NPI registry since July 2013. She is enrolled in Medicare PECOS, maintains a secondary practice location in Springfield, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1477995611
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARY T. DAMBACHERCredential: FNP-BC
Location Address2200 SHALE STSpringfield, IL 62703-5625
Mailing Address2239 E Cook StSpringfield, IL 62703-1944 · (217) 788-2300
Phone(217) 788-2321
Fax(217) 679-7291
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateJuly 29, 2013
Last NPPES UpdateJune 13, 20252 updates tracked since enumeration
NPPES CertifiedJune 13, 2025
✔ NPI 1477995611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209010559
2200 SHALE ST, Springfield, IL 62703
Open in Google Maps ↗

Secondary Practice Location 1

Location 12239 E Cook StSpringfield, IL 62703-1944 · Phone (217) 788-2300 · Fax (217) 788-2341

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary T. Dambacher Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4486888591
PECOS Enrollment IDI20131003000168
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mary Dambacher reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Central Counties Health Centers, Inc.
1.3 mi
Federally Qualified Health Center (FQHC)
2239 E COOK ST
Springfield, IL 62703
  • Reassigned Medicare billing, Illinois enrollment
  • 20 clinicians in this Medicare group
NPI 1861480709 (217) 788-2300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
33 services32 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
25 services25 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62703 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

72.14/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.96
Improvement Activities40
Cost53.06

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Continuous positive airway pressure (cpap) device E0601
DME-Other DME · category DE001N
2 suppliers12 claims12 services$32.97 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Dambacher's NPI number?

The NPI number for Mary Dambacher is 1477995611. It was assigned to this individual provider in the NPPES registry on July 29, 2013.

Where is Mary Dambacher located?

Mary Dambacher practices at 2200 Shale St, Springfield, IL 62703. The listed phone number is (217) 788-2321.

What is Mary Dambacher's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Mary Dambacher enrolled in Medicare?

Yes. Mary Dambacher is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mary Dambacher's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Dambacher reassigns Medicare benefits to Central Counties Health Centers, Inc. (Springfield, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Dambacher's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mary Dambacher was last updated on June 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.