Active NPI
Todd W Anderson, MD
- Diagnostic Radiology Physician
- Springfield, IL
National Provider Identifier
1477594026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 036105321
- Practice address
- 3050 Montvale Dr Ste a
Springfield, IL 62704-6924 - Phone
- (217) 726-8096
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 036105321 | IL | Primary |
Addresses
Primary practice location
3050 Montvale Dr Ste a
Springfield, IL 62704-6924
Mailing address
2040 W Iles Ave
Suite C
Springfield, IL 62704-4183
Phone (217) 789-0668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036105321 | Medicaid | IL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438560000000",
"number": "1477594026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2040 W ILES AVE",
"address_2": "SUITE C",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627044183",
"telephone_number": "217-789-0668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3050 MONTVALE DR STE A",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627046924",
"telephone_number": "217-726-8096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "TODD",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2015-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IL",
"license": "036105321",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036105321",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.