NPIMap

Organization Active NPI

The Carbondale Clinic Radiology

  • Diagnostic Radiology Physician
  • Carbondale, IL
National Provider Identifier
1285790519
Registry record updated May 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
THE CARBONDALE CLINIC RADIOLOGY
Practice address
2601 W Main St
Carbondale, IL 62901-1031
Phone
(618) 457-5200
Fax
(618) 549-5128
NPI assigned
Dec 29, 2006
Organization subpart
Yes
Parent organization
THE CARBONDALE CLINIC, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2008

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

Authorized official

Name
Mr. Allan N Norman
Title
Chief Executive Officer
Phone
(618) 457-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2601 W Main St
Carbondale, IL 62901-1031

Mailing address

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 457-5200

Other identifiers 5

IdentifierTypeStateIssuer
614350OtherILLEGACY
044651OtherILHAMP
464790OtherILHEALTHLINK
690006448OtherILRR MEDICARE
196090OtherILGHP

National Provider Directory

National Provider Directory
Tax ID family
Carvondale Clinic5 organizations share this tax ID, including this one
Part of
Carvondale Clinic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1285790519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-457-5200",
            "fax_number": "618-549-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-457-5200",
            "fax_number": "618-549-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CARBONDALE CLINIC RADIOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CARBONDALE CLINIC, S.C.",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-457-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGACY",
            "identifier": "614350",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAMP",
            "identifier": "044651",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "464790",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "690006448",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "196090",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.