NPIMap

Organization Active NPI

Center for Autism Spectrum Disorders

  • Clinic/Center
  • Carbondale, IL
National Provider Identifier
1477797801
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CENTER FOR AUTISM SPECTRUM DISORDERS
Practice address
625 Wham Dr -Mailcode 6607
Southern Illinois University Carbondale
Carbondale, IL 62901-4313
Phone
(618) 536-2122
Fax
(618) 453-7178
NPI assigned
Apr 29, 2009
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Valerie Boyer, PH.D.
Title
Center Director
Phone
(618) 453-7130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

625 Wham Dr -Mailcode 6607
Southern Illinois University Carbondale
Carbondale, IL 62901-4313

Mailing address

625 Wham Dr
Southern Illinois University Carbondale
Carbondale, IL 62901-4313
Phone (618) 536-2122

Other names 1

  • The Autism Program at Southern Illinois University Carbondale Other name

National Provider Directory

National Provider Directory
Tax ID family
Susan M Tucker MD29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

625 Wham Dr
Carbondale, IL 62901

625 Wham Dr
#6607
Carbondale, IL 62901
Phone (618) 453-7168

Practitioners & affiliated clinicians

Practitioners 2

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": "1240963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1477797801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 WHAM DR",
            "address_2": "SOUTHERN ILLINOIS UNIVERSITY CARBONDALE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629014313",
            "telephone_number": "618-536-2122",
            "fax_number": "618-453-7178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 WHAM DR -MAILCODE 6607",
            "address_2": "SOUTHERN ILLINOIS UNIVERSITY CARBONDALE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629014313",
            "telephone_number": "618-536-2122",
            "fax_number": "618-453-7178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR AUTISM SPECTRUM DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-29",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "CENTER DIRECTOR",
        "authorized_official_telephone_number": "618-453-7130",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Autism Program at Southern Illinois University Carbondale",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.