Individual provider Active NPI

Alan E Harris, MD

  • Diagnostic Radiology Physician
  • St. Louis, MO
National Provider Identifier
1225075302
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036093945 Issued in IL
Practice address
VA St. Louis Medical Center
915 North Grand Blvd.
St. Louis, MO 63106
Phone
(314) 652-4100
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036093945 IL Primary

Addresses

Primary practice location

VA St. Louis Medical Center
915 North Grand Blvd.
St. Louis, MO 63106

Mailing address

1370 Bossler LN
O Fallon, IL 62269-7128
Phone (618) 304-1158

Other identifiers 2

IdentifierTypeStateIssuer
0360939452MedicaidIL
1355486OtherTNBCBS OF TN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040429000118 IL Practitioner - Diagnostic Radiology 6709775042 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Howard University College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Specialists in Medical Imaging SCGroup PAC ID 2163733544, 228 clinicians

Practice addresses (Care Compare)

640 W Washington St
Pittsfield, IL 62363-1350
Phone (309) 671-8282

Hospital & facility affiliations

  • Blessing Hospital Hospital, Quincy, IL, CCN 140015
  • Illini Community Hospital Hospital, Pittsfield, IL, CCN 141315

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036093945ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Graham Hospital Association CurrentSince Sep 3, 2024 Accepting new patients
Graham Hospital Association CurrentSince Sep 3, 2024 Accepting new patients
Graham Hospital Association Current Accepting new patients
Blessing Hospital CurrentSince Oct 1, 2023 Accepting new patients
Specialists in Medical Imaging, SC Diagnostic Radiology CurrentSince Nov 14, 2020 Accepting new patients
Blessing Hospital CurrentSince Oct 1, 2023 Accepting new patients
Rockford Health Physicians CurrentSince Feb 1, 2016 Accepting new patients
Radiology Consultants of Mid-America, PC Diagnostic Radiology PastSince Jul 1, 2013 Accepting new patients
Advanced Diagnostic Imaging LTD Diagnostic Radiology Past Accepting new patients

Locations

210 W Walnut St
Canton, IL 61520
Phone (309) 647-5240

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

4646 N Marine Dr
Chicago, IL 60640
Phone (773) 564-5102

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

640 W Washington St
Pittsfield, IL 62363
Phone (217) 285-2113

4800 Maine St
Quincy, IL 62305
Phone (217) 214-0444

1005 Broadway St
Quincy, IL 62301

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

101 Medical Dr
Hannibal, MO 63401

100 Medical Dr
Hannibal, MO 63401

103 E Commercial St
Kahoka, MO 63445
Phone (660) 727-3377

Interoperability endpoints

  • FHIR API: https://fhir.blessinghospital.com/R4/open-Prod

Organizations & group practices 9

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

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1225075302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 BOSSLER LN",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697128",
            "telephone_number": "618-304-1158",
            "fax_number": "618-624-4934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VA ST. LOUIS MEDICAL CENTER",
            "address_2": "915 NORTH GRAND BLVD.",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63106",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "ALAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036093945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360939452",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "1355486",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Louis, MO

Sources for this page

Verify at the official NPI Registry.