NPIMap

Organization Active NPI

Tri-State Radiation Oncology Centers LLC

  • Radiation Oncology Clinic/Center
  • Evansville, IN
National Provider Identifier
1225274244
Registry record updated Oct 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
Legal business name
TRI-STATE RADIATION ONCOLOGY CENTERS LLC
Practice address
700 N Burkhardt Rd
Evansville, IN 47715-2740
Phone
(812) 474-1110
Fax
(812) 474-1303
NPI assigned
Dec 22, 2008
Last updated
Oct 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2009

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

Authorized official

Name
Joe Chang
Title
Chairperson
Phone
(310) 335-4000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X NU Primary
Radiation Oncology Physician 2085R0001X NU
Diagnostic Radiology Physician 2085R0202X NU

Addresses

Primary practice location

700 N Burkhardt Rd
Evansville, IN 47715-2740

Mailing address

PO Box 2084
Indianapolis, IN 46206-2084
Phone (800) 331-9294

Other identifiers 3

IdentifierTypeStateIssuer
200926120AMedicaidIN
200926120BMedicaidIN
DP0313OtherINRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090212000084 IN Part B Supplier - Clinic/Group Practice 8628133394 Receives reassigned benefits from 6 practitioners
Practice locations: Evansville, IN; Newburgh, IN

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4055 Gateway Blvd
Newburgh, IN 47630
Phone (812) 842-2210

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1225274244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2084",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462062084",
            "telephone_number": "800-331-9294",
            "fax_number": "812-471-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N BURKHARDT RD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152740",
            "telephone_number": "812-474-1110",
            "fax_number": "812-474-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE RADIATION ONCOLOGY CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "CHAIRPERSON",
        "authorized_official_telephone_number": "310-335-4000"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200926120A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200926120B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DP0313",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; 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.

Verify at the official NPI Registry.