Individual provider Active NPI

Michael Carroll, M.D.

  • Anesthesiology Physician
  • Urbana, IL
National Provider Identifier
1457386351
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036084204 Issued in IL
Practice address
602 W University Ave
Urbana, IL 61801-2530
Phone
(217) 383-3311
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036084204 IL Primary

Addresses

Primary practice location

602 W University Ave
Urbana, IL 61801-2530

Mailing address

602 W University Ave
Urbana, IL 61801-2530
Phone (217) 383-3311

Other identifiers 2

IdentifierTypeStateIssuer
050021669OtherILRAILROAD NUMBER
1457386351OtherILNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20090313000077 IL Practitioner - Anesthesiology 3476595265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036084204ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated Anesthesiology CurrentSince Apr 1, 2010 Accepting new patients

Locations

1000 Medical Center Dr
Monticello, IL 61856
Phone (217) 762-1540

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

810 W Anthony Dr
Urbana, IL 61802
Phone (217) 326-2911

Interoperability endpoints

  • Direct secure messaging: mcarrollmd88596@carlehiedirect.net

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338854400000",
    "number": "1457386351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 W UNIVERSITY AVE",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012530",
            "telephone_number": "217-383-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 W UNIVERSITY AVE",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012530",
            "telephone_number": "217-383-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2012-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036084204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD NUMBER",
            "identifier": "050021669",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1457386351",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.