NPIMap

Organization Active NPI

Northern Illinois Cancer Treatment Center

  • Radiation Oncology Physician
  • Dixon, IL
National Provider Identifier
1386644995
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NORTHERN ILLINOIS CANCER TREATMENT CENTER
Practice address
327 Il Route 2
Dixon, IL 61021-9118
Phone
(815) 284-1111
Fax
(815) 284-2306
NPI assigned
Jul 26, 2005
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
Jon Berens
Title
Authorized Official
Phone
(815) 284-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X Primary

Addresses

Primary practice location

327 Il Route 2
Dixon, IL 61021-9118

Mailing address

327 Il Route 2
Dixon, IL 61021-9118
Phone (815) 284-1111

Other identifiers 1

IdentifierTypeStateIssuer
05215222OtherILBLUE SHIELD PROVIDER NUMB

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Dixon Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050107000651 IL Part B Supplier - Clinic/Group Practice 6709834567 Receives reassigned benefits from 4 practitioners
Practice locations: Dixon, IL

National Provider Directory

National Provider Directory

Locations

327 Illinois Route 2
Dixon, IL 61021
Phone (815) 284-1111

Practitioners & affiliated clinicians

Practitioners 11

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": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1386644995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 IL ROUTE 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-1111",
            "fax_number": "815-284-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 IL ROUTE 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-1111",
            "fax_number": "815-284-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS CANCER TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2024-01-02",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "BERENS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "815-284-1111"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "05215222",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Dixon",
            "affiliation": "N",
            "endpointDescription": "Radiation Oncology",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "327 Il Route 2",
            "city": "Dixon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610219118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; 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.