NPIMap

Organization Active NPI

Cancer Therapy Medical Group Inc

  • Radiation Oncology Physician
  • Rohnert Park, CA
National Provider Identifier
1649280520
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
CANCER THERAPY MEDICAL GROUP INC
Practice address
301 Professional Center Dr
Rohnert Park, CA 94928-2152
Phone
(707) 584-2200
Fax
(707) 584-7582
NPI assigned
Aug 9, 2006
Organization subpart
Yes
Parent organization
CANCER THERAPY MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Dr. Jonathan Humphrey, MD
Title
Medical Director
Phone
(925) 952-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

301 Professional Center Dr
Rohnert Park, CA 94928-2152

Mailing address

PO Box 756
Danville, CA 94526-0756
Phone (877) 866-0914

Other identifiers 3

IdentifierTypeStateIssuer
GR0092410MedicaidCA
DC7191OtherRAILROAD MCARE
ZZZ04964ZOtherBLUE SHIELD

Other names 1

  • Rohnert Park Cancer Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000651 CA Part B Supplier - Clinic/Group Practice 6800792003 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fresno, CA; Rohnert Park, CA; Sacramento, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cancer Therapy Medical Group Inc4 organizations share this tax ID, including this one
Part of
Cancer Therapy Medical Group Inc

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1649280520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 756",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945260756",
            "telephone_number": "877-866-0914",
            "fax_number": "209-343-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PROFESSIONAL CENTER DR",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282152",
            "telephone_number": "707-584-2200",
            "fax_number": "707-584-7582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER THERAPY MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANCER THERAPY MEDICAL GROUP INC",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "925-952-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0092410",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "DC7191",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ04964Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rohnert Park Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rohnert Park Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rohnert Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.