Active NPI
Charles G Groen, MD
- Radiation Oncology Physician
- Niles, IL
National Provider Identifier
1497742860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 01068054A
- Practice address
- 8915 W Golf Rd
3Rd Floor
Niles, IL 60714-5905 - Phone
- (847) 827-9490
- Fax
- (847) 827-2241
- NPI assigned
- Sep 30, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 036085244 | IL | |
| Radiation Oncology Physician | 2085R0001X | 01068054A | IN | Primary |
Addresses
Primary practice location
8915 W Golf Rd
3Rd Floor
Niles, IL 60714-5905
Mailing address
3610 Paysphere Cir
Chicago, IL 60674-0036
Phone (847) 585-7000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000726585 | Other | IN | ANTHEM PROVIDER NUMBER |
| 036085244 | Medicaid | IL | |
| 201034800 | Medicaid | IN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Cancer Center | Past | Accepting new patients |
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.
-
- Radiation Oncology Clinic/Center
- Elgin, IL
- NPI 1750401196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1497742860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3610 PAYSPHERE CIR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606740036",
"telephone_number": "847-585-7000",
"fax_number": "847-240-0622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8915 W GOLF RD",
"address_2": "3RD FLOOR",
"city": "NILES",
"state": "IL",
"postal_code": "607145905",
"telephone_number": "847-827-9490",
"fax_number": "847-827-2241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROEN",
"first_name": "CHARLES",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IL",
"license": "036085244",
"primary": false
},
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IN",
"license": "01068054A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000000726585",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036085244",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201034800",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Niles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.