Individual provider Active NPI

Tina M Molis, M.D.

  • Diagnostic Radiology Physician
  • Champaign, IL
National Provider Identifier
1336167287
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036-122369 Issued in IL
Practice address
101 W University Ave
Champaign, IL 61820-3909
Phone
(217) 366-1285
Fax
(217) 366-6129
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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 036-122369 IL Primary

Addresses

Primary practice location

101 W University Ave
Champaign, IL 61820-3909

Mailing address

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1326

Other identifiers 2

IdentifierTypeStateIssuer
279500OtherILMEDICARE GROUP
200520830AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmolismd287396@CarleHieDirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050811000204 IN Practitioner - Diagnostic Radiology 2668401571 Reassigns benefits to 1 organization
I20090416000012 IL Practitioner - Diagnostic Radiology 2668401571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Louisiana State University School of Medicine in Shreveport, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christie Clinic, PLLCGroup PAC ID 7719899319, 219 clinicians

Practice addresses (Care Compare)

Newburgh, IN 47630
Phone (217) 366-8107

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-122369ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christie Clinic, PLLC CurrentSince Mar 9, 2009 Accepting new patients
Advanced Diagnostic Imaging, PC Diagnostic Radiology Past Accepting new patients

Locations

101 W University Ave
Champaign, IL 61820
Phone (217) 366-1255

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

Interoperability endpoints

  • Direct secure messaging: tmolismd287396@carlehiedirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1336167287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203909",
            "telephone_number": "217-366-1326",
            "fax_number": "217-366-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203909",
            "telephone_number": "217-366-1285",
            "fax_number": "217-366-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLIS",
        "first_name": "TINA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036-122369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "279500",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200520830A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmolismd287396@CarleHieDirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "101 W University Ave",
            "city": "Champaign",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618203909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.