NPIMap

Organization Active NPI

Southern Illinois Radiation Oncology LLC

  • Radiation Oncology Physician
  • Carterville, IL
National Provider Identifier
1447318050
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
SOUTHERN ILLINOIS RADIATION ONCOLOGY LLC
Practice address
1400 Pin Oak Dr
Carterville, IL 62918-1600
Phone
(618) 985-3333
Fax
(618) 985-1315
NPI assigned
Dec 5, 2006
Last updated
Mar 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Authorized official

Name
Michael Little, MDNPI 1093915902
Title
Medical Director
Phone
(618) 985-3333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

1400 Pin Oak Dr
Carterville, IL 62918-1600

Mailing address

600 West Main Street
Suite 3
Carbondale, IL 62901-2604
Phone (618) 529-3159

Other identifiers 1

IdentifierTypeStateIssuer
036078040MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070309000151 IL Part B Supplier - Clinic/Group Practice 7315040474 Receives reassigned benefits from 3 practitioners
Practice locations: Carterville, IL

National Provider Directory

National Provider Directory

Locations

600 W Main St
Ste 3
Carbondale, IL 62901

Practitioners & affiliated clinicians

Practitioners 3

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": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1447318050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WEST MAIN STREET",
            "address_2": "SUITE 3",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012604",
            "telephone_number": "618-529-3159",
            "fax_number": "618-351-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PIN OAK DR",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629181600",
            "telephone_number": "618-985-3333",
            "fax_number": "618-985-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS RADIATION ONCOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "618-985-3333",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036078040",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carterville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.