NPIMap

Individual provider Active NPI

Paul Y. Song, M.D.

  • Radiation Oncology Physician
  • Evergreen Park, IL
National Provider Identifier
1366483471
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
G88014 Issued in CA
Practice address
2800 W 95TH St
Cancer Center
Evergreen Park, IL 60805-2746
Phone
(708) 423-6286
Fax
(708) 499-3842
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 036090350 IL
Radiation Oncology Physician 2085R0001X G88014 CA Primary

Addresses

Primary practice location

2800 W 95TH St
Cancer Center
Evergreen Park, IL 60805-2746

Mailing address

PO Box 10050
Manhattan Beach, CA 90267-7550
Phone (213) 744-1460

Other identifiers 1

IdentifierTypeStateIssuer
036090350MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G88014CAMDRadiation Oncology Physician
036090350ILMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Community Care Past Accepting new patients
West Hills Hospital Past Accepting new patients
Valley Radiotherapy Associates Medical Group Inc Radiation Oncology Past Accepting new patients
Radiation Therapy Consultants, LTD. Radiation Oncology Past Accepting new patients
Palos Community Hospital Past Accepting new patients
Radiation Oncology, S.C. Radiation Oncology Past Accepting new patients
Radiation Oncology Associates, PC Radiation Oncology Past Accepting new patients
Valley Radiotherapy Associates Medical Group Inc Past Accepting new patients
Queens Medical Radiotherapy PC Radiation Oncology Past Accepting new patients
Valley Oncology, P.C. Radiation Oncology Past Accepting new patients
Dignity Health Past Accepting new patients
Little Company of Mary Affiliated Services Inc Past Accepting new patients
Radiation Oncology, SC Radiation Oncology Past Accepting new patients

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1366483471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10050",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902677550",
            "telephone_number": "213-744-1460",
            "fax_number": "213-744-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W 95TH ST",
            "address_2": "CANCER CENTER",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052746",
            "telephone_number": "708-423-6286",
            "fax_number": "708-499-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "PAUL",
        "middle_name": "Y.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": "036090350",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "G88014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036090350",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.