NPIMap

Individual provider Active NPI

Randy John Jung, M.D.

  • Psychiatry Physician
  • Belleville, IL
National Provider Identifier
1205917176
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036085990 Issued in IL
Practice address
301 W Lincoln St
Suite 106
Belleville, IL 62220-1901
Phone
(618) 235-1582
Fax
(618) 235-2473
NPI assigned
Oct 18, 2006
Last updated
Apr 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036085990 IL Primary
Geriatric Psychiatry Physician 2084P0805X 036085990 IL

Addresses

Primary practice location

301 W Lincoln St
Suite 106
Belleville, IL 62220-1901

Mailing address

PO Box 354
Suite 106
Belleville, IL 62222-0354
Phone (618) 235-1582

Other identifiers 1

IdentifierTypeStateIssuer
036085990MedicaidIL

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
I20080107000040 IL Practitioner - PsychiatryPractitioner - Hospitalist 5193805943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Southern Illinois University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Touchette Regional Hospital IncGroup PAC ID 7416843370, 46 clinicians

Practice addresses (Care Compare)

5900 Bond Ave
Cahokia Heights, IL 62207-2326
Phone (618) 332-3060

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation, Inc Psychiatry CurrentSince Dec 18, 2017 Accepting new patients
Southern Illinois Healthcare Foundation Inc Current Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Dec 18, 2017 Accepting new patients
Touchette Regional Hospital Inc CurrentSince Jan 1, 2016 Accepting new patients
Touchette Regional Hospital, Inc. Past Accepting new patients

Locations

2 Memorial Dr
Ofc
Alton, IL 62002
Phone (618) 332-4081

180 S 3rd St
Ste 250
Belleville, IL 62220
Phone (618) 213-7964

5900 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-3060

6000 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-2740

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

2041 Goose Lake Rd
Sauget, IL 62206

2071 Goose Lake Rd
Sauget, IL 62206
Phone (314) 872-1473

Organizations & group practices 6

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1205917176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 354",
            "address_2": "SUITE 106",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622220354",
            "telephone_number": "618-235-1582",
            "fax_number": "618-235-2473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W LINCOLN ST",
            "address_2": "SUITE 106",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201901",
            "telephone_number": "618-235-1582",
            "fax_number": "618-235-2473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "RANDY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036085990",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "IL",
            "license": "036085990",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085990",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.