Radiologic Interpretations of Southern Illinois LTD

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

Legal business name

RADIOLOGIC INTERPRETATIONS OF SOUTHERN ILLINOIS LTD

Practice address

1200 Cedar Court
Carbondale, IL 62901-5334

Phone

(618) 529-8500

Fax

(618) 549-1000

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Douglas L Fulk, MDNPI 1992780050

Title

President

Phone

(618) 529-8500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Locations

Practitioners 2

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

• Douglas L Fulk, M.D.

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1992780050

  IL, MO

  Medicare reassignment NPD Authorized official
• Daniel Raymond Fulk, D.O.

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1962432286

  IL, MO

  Medicare reassignment NPD

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1730218652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CEDAR COURT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500",
            "fax_number": "618-549-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CEDAR COURT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500",
            "fax_number": "618-549-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGIC INTERPRETATIONS OF SOUTHERN ILLINOIS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "FULK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-529-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Elizabeth Prudencio, LCSW
• Psychological Services and Chronic Pain Management Inc.
• Shawn Wayne Pyle, CRNA
• Debra Renee Queen, R.D.
• Gloria Queriapa-Valdes, BAS, CD (DONA)
• Michael Rafati, MD
• Rainbow Cafe Lgbtq Center
• Srinivas Rajamahanty, M.D.
• Daniel Ralls, PA
• Susan M Ramirez, PH.D.

• All providers in Carbondale, IL
• Radiologic Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; 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.