Active NPI
Northern Illinois University
- Radiation Oncology Clinic/Center
- Batavia, IL
National Provider Identifier
1144327487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Clinic/Center
- Legal business name
- NORTHERN ILLINOIS UNIVERSITY
- Practice address
- Kirk and Pine Rd
Batavia, IL 60510 - Phone
- (630) 840-3865
- NPI assigned
- Sep 20, 2006
- Organization subpart
- Yes
- Parent organization
- NORTHERN ILLINOIS UNIVERSITY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Peters, PHD
- Title
- President
- Phone
- (815) 753-9500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Clinic/Center | 261QX0203X | Primary |
Addresses
Primary practice location
Kirk and Pine Rd
Batavia, IL 60510
Mailing address
307 Lowden Hall
Niu Outreach
Dekalb, IL 60115-3080
Phone (815) 753-0924
Other names 1
- Northern Illinois University Institute for Neutron Therapy at Fermilab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050104000460 | IL | Part B Supplier - Clinic/Group Practice | 2860440195 |
Receives reassigned benefits from 17 practitioners 4 other NPIs on this enrollment Practice locations: Dekalb, IL |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Physical Therapy Clinic/Center
- Dekalb, IL
- NPI 1194991216
O20050104000460
-
- Physical Therapy Clinic/Center
- Dekalb, IL
- NPI 1821251430
O20050104000460
National Provider Directory
National Provider Directory- Part of
- Northern Ill University
Locations
307 Lowden Hall
DeKalb, IL 60115
Practitioners & affiliated clinicians
Practitioners 28
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210636800000",
"number": "1144327487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 LOWDEN HALL",
"address_2": "NIU OUTREACH",
"city": "DEKALB",
"state": "IL",
"postal_code": "601153080",
"telephone_number": "815-753-0924",
"fax_number": "815-753-0666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "KIRK AND PINE RD",
"city": "BATAVIA",
"state": "IL",
"postal_code": "60510",
"telephone_number": "630-840-3865"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHERN ILLINOIS UNIVERSITY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NORTHERN ILLINOIS UNIVERSITY",
"enumeration_date": "2006-09-20",
"last_updated": "2008-05-13",
"status": "A",
"authorized_official_last_name": "PETERS",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "815-753-9500",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "261QX0203X",
"taxonomy_group": "",
"desc": "Clinic/Center, Oncology, Radiation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Northern Illinois University Institute for Neutron Therapy at Fermilab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Batavia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.