Pramern Sriratana, M.D.
Individual provider Active NPI Hematology & Oncology Physician · Normal, IL
NPI 1174522189 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1174522189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 036050943 (IL)
- Practice address
- 1606 Hunt Dr
Normal, IL 61761-2192 - Phone
- (309) 452-9701
- Fax
- (309) 454-1957
- NPI assigned
- Jul 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 29
Medicare Care Compare profile
- Specialty
- Hematology/Oncology
- Education
- Other, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mid-Illinois Hematology Oncology Associates LTD
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
- Carle Hospice
- Saint James Hospital
- Carle Bromenn Medical Center
- Gibson Community Hospital
- St Joseph Medical Center
- Warner Hospital and Health Services
- Arc at Normal
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090105000093 | IL | Practitioner - Hematology/Oncology | 0446312201 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036050943 | IL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Illinois Hematology Oncology Associates LTD | Hematology & Oncology | Current |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036050943 | IL | |
| Hematology & Oncology Physician | 207RH0003X | 036050943 | IL | Yes |
Addresses
Primary practice location
1606 Hunt Dr
Normal, IL 61761-2192
Mailing address
1606 Hunt Dr
Normal, IL 61761-2192
Phone (309) 452-9701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036050943 | Medicaid | IL |
Other providers in Normal, IL
- Marilyn Snook
- Alan Sobery
- Dorene Solava
- Jill Ellyn Sparrow
- Stephanie Sprague
- St Joseph Medical Center
- Sydney Stacy
- Michelle Dee Staley
- Justin M. Stanek
- Spencer Stanesa
All providers in Normal, IL · Hematology & Oncology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.