NPIMap

Individual provider Active NPI

Pramern Sriratana, M.D.

  • Hematology & Oncology Physician
  • Normal, IL
National Provider Identifier
1174522189
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
036050943 Issued in IL
Practice address
1606 Hunt Dr
Normal, IL 61761-2192
Phone
(309) 452-9701
Fax
(309) 454-1957
NPI assigned
Jul 20, 2005
Last updated
Feb 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036050943 IL
Hematology & Oncology Physician 207RH0003X 036050943 IL Primary

Addresses

Primary practice location

1606 Hunt Dr
Normal, IL 61761-2192

Mailing address

1606 Hunt Dr
Normal, IL 61761-2192
Phone (309) 452-9701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090105000093 IL Practitioner - Hematology/Oncology 0446312201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Illinois Hematology Oncology Associates LTDGroup PAC ID 7618039470, 4 clinicians

Practice addresses (Care Compare)

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

1606 Hunt Dr
Normal, IL 61761-2192
Phone (309) 452-9701

422 W White St
Clinton, IL 61727-2272
Phone (217) 935-9571

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036050943ILMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Illinois Hematology Oncology Associates LTD Hematology & Oncology CurrentSince Jan 1, 1990 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

422 W White St
Clinton, IL 61727
Phone (217) 935-9570

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

1606 Hunt Dr
Normal, IL 61761
Phone (309) 451-8888

407 E Vernon Ave
Ste 104
Normal, IL 61761
Phone (309) 287-7539

608 N Ladd St
Pontiac, IL 61764
Phone (815) 842-4584

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1174522189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 HUNT DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612192",
            "telephone_number": "309-452-9701",
            "fax_number": "309-454-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 HUNT DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612192",
            "telephone_number": "309-452-9701",
            "fax_number": "309-454-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIRATANA",
        "first_name": "PRAMERN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036050943",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036050943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.