NPIMap

Organization Active NPI

Carle Clinic Association

  • General Acute Care Hospital
  • Champaign, IL
National Provider Identifier
1609906999
Registry record updated Aug 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
036-115508 Issued in IL
Legal business name
CARLE CLINIC ASSOCIATION
Practice address
701 Krebs Dr
Champaign, IL 61822
Phone
(217) 355-7951
NPI assigned
Mar 6, 2007
Last updated
Aug 31, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2009

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

Authorized official

Name
Zuheir Kassabo, MD
Title
Hospitalist
Phone
(217) 355-7951

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 036-115508 IL Primary
Internal Medicine Physician 207R00000X 036-115508 IL

Addresses

Primary practice location

701 Krebs Dr
Champaign, IL 61822

Mailing address

701 Krebs Dr
Champaign, IL 61822

Other identifiers 4

IdentifierTypeStateIssuer
833120OtherMEDICARE GROUP #
CA2264OtherILRR GROUP #
P00729199OtherILRR MEDICARE INDIVIDUAL #
036115508MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Carle Clinic Association PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1609906999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 KREBS DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 KREBS DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61822",
            "telephone_number": "217-355-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLE CLINIC ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "KASSABO",
        "authorized_official_first_name": "ZUHEIR",
        "authorized_official_title_or_position": "HOSPITALIST",
        "authorized_official_telephone_number": "217-355-7951",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "036-115508",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-115508",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "833120",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP #",
            "identifier": "CA2264",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE INDIVIDUAL #",
            "identifier": "P00729199",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115508",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.