Donald E Banicki, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

3604438 Issued in IL

Practice address

6426 Old Hunters Run
Rockford, IL 61114-7812

Phone

(815) 633-5995

Fax

(815) 633-5995

NPI assigned

Jul 18, 2008

Last updated

Jul 18, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1295999225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6426 OLD HUNTERS RUN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611147812",
            "telephone_number": "815-633-5995",
            "fax_number": "815-633-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6426 OLD HUNTERS RUN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611147812",
            "telephone_number": "815-633-5995",
            "fax_number": "815-633-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANICKI",
        "first_name": "DONALD",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "3604438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palanikumar Balasundaram, MD
• Antonio R Baluga, MD
• Herath Mudiyanselage Bandara, MD
• May Marne Jabines Bandilla, PHARMD
• Samantha Ann Baney, APRN
• Brittany L Bankes, NP
• Brittany Bankord
• Lesly Y Banos, DMD
• Errol Christopher Baptist, M.D.
• Sarah Baranski, MMN, RDN

• Diagnostic Radiology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.