Individual provider Active NPI

Justin D Floyd, DO

  • Medical Oncology Physician
  • O'Fallon, IL
National Provider Identifier
1629164678
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
036112641 Issued in IL
Practice address
321 Regency Park Ste 100
O Fallon, IL 62269-1887
Phone
(618) 416-7970
Fax
(618) 416-7971
NPI assigned
Oct 5, 2006
Last updated
Dec 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 2001014924 MO
Medical Oncology Physician 207RX0202X 036112641 IL Primary

Addresses

Primary practice location

321 Regency Park Ste 100
O Fallon, IL 62269-1887

Mailing address

210W McKinley Ave 1
Decatur, IL 62526-5858
Phone (217) 877-9442

Other practice location 1

9515 Holy Cross Ln Ste 6
Breese, IL 62230-3618
Phone (618) 416-7970

Other practice location 2

1900 State St
Chester, IL 62233-1116
Phone (618) 826-4581

Other identifiers 1

IdentifierTypeStateIssuer
036112641MedicaidIL

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
I20050214000796 IL Practitioner - Hematology/OncologyPractitioner - Internal MedicinePractitioner - Medical Oncology 4486552973 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial HospitalGroup PAC ID 5294649372, 29 clinicians

Practice addresses (Care Compare)

1900 State St
Chester, IL 62233-1116
Phone (618) 826-4581

321 Regency Park
Suite 100
O Fallon, IL 62269-1887
Phone (618) 416-7970

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital CurrentSince Apr 4, 2013 Accepting new patients
Cancer Care Specialists of Central Illinois, S.C CurrentSince Aug 17, 2015 Accepting new patients
Memorial Hospital CurrentSince Apr 4, 2013 Accepting new patients
Cancer Care Specialists of Central Illinois, S.C. Medical Oncology CurrentSince Aug 17, 2015 Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients

Locations

9515 Holy Cross Ln
Ste 6
Breese, IL 62230
Phone (618) 416-7970

1900 State St
Chester, IL 62233
Phone (618) 826-2388

210 W McKinley Ave
#1
Decatur, IL 62526
Phone (217) 877-9442

321 Regency Park
Ste 100
O Fallon, IL 62269
Phone (618) 416-7970

13 Wolf Creek Dr
Ste 1
Swansea, IL 62226
Phone (314) 290-7501

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1629164678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210W MCKINLEY AVE 1",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625265858",
            "telephone_number": "217-877-9442",
            "fax_number": "217-876-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 REGENCY PARK STE 100",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691887",
            "telephone_number": "618-416-7970",
            "fax_number": "618-416-7971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9515 Holy Cross Ln Ste 6",
            "address_purpose": "LOCATION",
            "city": "Breese",
            "state": "IL",
            "postal_code": "622303618",
            "country_code": "US",
            "telephone_number": "618-416-7970",
            "fax_number": "618-416-7971",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 State St",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "IL",
            "postal_code": "622331116",
            "country_code": "US",
            "telephone_number": "618-826-4581",
            "fax_number": "618-826-5152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLOYD",
        "first_name": "JUSTIN",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MO",
            "license": "2001014924",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "IL",
            "license": "036112641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112641",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.