NPIMap

Organization Active NPI

Siouxland Regional Cancer Center

  • Hematology & Oncology Physician
  • Sioux City, IA
National Provider Identifier
1114904604
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
SIOUXLAND REGIONAL CANCER CENTER
Practice address
230 Nebraska St
Sioux City, IA 51101-1733
Phone
(712) 252-0088
Fax
(712) 252-9404
NPI assigned
Dec 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Ms. Krista J McCullough
Title
Executive Director
Phone
(712) 252-9301

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X Primary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

230 Nebraska St
Sioux City, IA 51101-1733

Mailing address

PO Box 5017
Sioux City, IA 51102-5017
Phone (712) 252-9301

Other identifiers 3

IdentifierTypeStateIssuer
0460568MedicaidIA
10025264400MedicaidNE
50928OtherIAWELLMARK

Other names 1

  • JUNE E NYLEN CANCER CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050721000823 IA Part B Supplier - Clinic/Group Practice 9830148188 Receives reassigned benefits from 31 practitioners
Practice locations: Sioux City, IA; Storm Lake, IA; Orange City, IA; Cherokee, IA; Le Mars, IA; Onawa, IA
O20150326002268 IA DME Supplier - Multi-Specialty - Physician 9830148188 Practice locations: Sioux City, IA

National Provider Directory

National Provider Directory

Locations

1101 9th St SE
Sioux Center, IA 51250
Phone (712) 722-1271

230 Nebraska St
Ste 1
Sioux City, IA 51101

1200 Providence Rd
#C
Wayne, NE 68787
Phone (402) 375-3800

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1114904604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5017",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511025017",
            "telephone_number": "712-252-9301",
            "fax_number": "712-252-9337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011733",
            "telephone_number": "712-252-0088",
            "fax_number": "712-252-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUXLAND REGIONAL CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "712-252-9301",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0460568",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025264400",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "50928",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JUNE E NYLEN CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JUNE E NYLEN CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.